Healthcare Provider Details

I. General information

NPI: 1295848679
Provider Name (Legal Business Name): AHAMED J JIFFRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 EAST HIGHLAND AVENUE SUITE 312
SAN BERNARDINO CA
92404
US

IV. Provider business mailing address

399 EAST HIGHLAND AVENUE SUITE 312
SAN BERNARDINO CA
92404
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:
Title or Position:
Credential:
Phone: