Healthcare Provider Details

I. General information

NPI: 1053071647
Provider Name (Legal Business Name): BBDDD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25780 MISSION RD
LOMA LINDA CA
92354-2507
US

IV. Provider business mailing address

25780 MISSION RD
LOMA LINDA CA
92354-2507
US

V. Phone/Fax

Practice location:
  • Phone: 909-831-1724
  • Fax:
Mailing address:
  • Phone: 909-831-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID NINAN
Title or Position: CEO
Credential: DO
Phone: 909-831-1724