Provider Demographics
NPI:1699194423
Name:MJ MEDICAL GROUP,INC.
Entity Type:Organization
Organization Name:MJ MEDICAL GROUP,INC.
Other - Org Name:OCEANA GASTROENTEROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROULA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-306-5115
Mailing Address - Street 1:3943 IRVINE BLVD
Mailing Address - Street 2:BOX#40
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-8840
Mailing Address - Country:US
Mailing Address - Phone:951-934-0505
Mailing Address - Fax:
Practice Address - Street 1:2097 COMPTON AVE. BLDG#1- SUITE# 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7289
Practice Address - Country:US
Practice Address - Phone:949-306-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46078207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003916727OtherNPI
CAA03734Medicare UPIN