Provider Demographics
NPI:1952599680
Name:MJ PRISMA CORP
Entity Type:Organization
Organization Name:MJ PRISMA CORP
Other - Org Name:MJ PRISMA KIDS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIYANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ MELEDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTL
Authorized Official - Phone:787-602-3110
Mailing Address - Street 1:PO BOX 1621
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1621
Mailing Address - Country:US
Mailing Address - Phone:787-602-3110
Mailing Address - Fax:787-854-0255
Practice Address - Street 1:CARR 685 KM 2.9
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-602-3110
Practice Address - Fax:787-602-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty