Organization
MMJ COCOS BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARISOL PATINO (OWNER)
(219) 836-0011
Entity
Organization
Contact information
Practice address
921 RIDGE RD # 2, MUNSTER, IN 46321-1739
(219) 836-0011
(219) 836-0011
Mailing address
921 RIDGE RD # 2, MUNSTER, IN 46321-1739
(219) 836-0011
(219) 836-0011
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/13/2008
Last updated
07/24/2008
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