Provider Demographics
NPI:1629548615
Name:MOJO ENTERPRISES INC.
Entity Type:Organization
Organization Name:MOJO ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-217-9764
Mailing Address - Street 1:1844 MARKET ST UNIT NO409
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6283
Mailing Address - Country:US
Mailing Address - Phone:970-217-9764
Mailing Address - Fax:
Practice Address - Street 1:1004 EMERSON ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2416
Practice Address - Country:US
Practice Address - Phone:970-217-9764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare