Healthcare Provider Details

I. General information

NPI: 1265609119
Provider Name (Legal Business Name): JIFFRY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE SUITE 312
SAN BERNARDINO CA
92404-3808
US

IV. Provider business mailing address

399 E HIGHLAND AVE SUITE 312
SAN BERNARDINO CA
92404-3808
US

V. Phone/Fax

Practice location:
  • Phone: 909-886-8227
  • Fax: 909-883-3358
Mailing address:
  • Phone: 909-886-8227
  • Fax: 909-883-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA043501
License Number StateCA

VIII. Authorized Official

Name: DR. AHAMED J JIFFRY
Title or Position: OWNER
Credential: M.D.
Phone: 909-886-8227