MMJ Cocos Boutique Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MMJ COCOS BOUTIQUE INC

Practice address

921 Ridge Rd # 2
Munster, IN 46321-1739

Phone

(219) 836-0011

Fax

(219) 836-0011

NPI assigned

Feb 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marisol Patino

Title

Owner

Phone

(219) 836-0011

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1114195062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 RIDGE RD # 2",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211739",
            "telephone_number": "219-836-0011",
            "fax_number": "219-836-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 RIDGE RD # 2",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211739",
            "telephone_number": "219-836-0011",
            "fax_number": "219-836-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMJ COCOS BOUTIQUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "PATINO",
        "authorized_official_first_name": "MARISOL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-836-0011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Munster, IN
• Providers in Munster, IN by specialty
• Prosthetic/Orthotic Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.