Provider Demographics
NPI:1316969991
Name:JB MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:JB MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-982-8044
Mailing Address - Street 1:1004 W FOOTHILL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3790
Mailing Address - Country:US
Mailing Address - Phone:909-982-8044
Mailing Address - Fax:909-982-0144
Practice Address - Street 1:1004 W FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3790
Practice Address - Country:US
Practice Address - Phone:909-982-8044
Practice Address - Fax:909-982-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88297Medicare UPIN
CA00C422240Medicare ID - Type Unspecified