Provider Demographics
NPI:1699870139
Name:MADANI, BADRAN (MD)
Entity type:Individual
Prefix:DR
First Name:BADRAN
Middle Name:
Last Name:MADANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SOUTH MOUNT VERNON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-886-3660
Mailing Address - Fax:909-824-2906
Practice Address - Street 1:952 S MOUNT VERNON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4218
Practice Address - Country:US
Practice Address - Phone:909-886-3660
Practice Address - Fax:909-824-2906
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine