Provider Demographics
NPI:1518004472
Name:MJ THERAPY SERVICES CORP.
Entity Type:Organization
Organization Name:MJ THERAPY SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-608-5608
Mailing Address - Street 1:119 CALLE RIO LAJAS
Mailing Address - Street 2:MONTE CASINO HEIGTHS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3750
Mailing Address - Country:US
Mailing Address - Phone:787-779-2274
Mailing Address - Fax:787-779-2274
Practice Address - Street 1:CARR. 863 KM. 2.2
Practice Address - Street 2:BO. PAJAROS CANDELARIA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5416
Practice Address - Country:US
Practice Address - Phone:787-251-5533
Practice Address - Fax:787-251-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1129261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ09669Medicare UPIN
PR0068140Medicare ID - Type Unspecified