Healthcare Provider Details

I. General information

NPI: 1548449564
Provider Name (Legal Business Name): FAMILY WELLNESS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3582 NATIONAL AVE SUITE #2
SAN DIEGO CA
92113-3157
US

IV. Provider business mailing address

190 AVENIDA ALTAMIRA
CHULA VISTA CA
91914-4602
US

V. Phone/Fax

Practice location:
  • Phone: 619-338-0787
  • Fax: 619-338-0782
Mailing address:
  • Phone: 619-338-0787
  • Fax: 619-338-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC038721
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC038721
License Number StateCA

VIII. Authorized Official

Name: DR. BABATUNDE ADEGBITE JINADU
Title or Position: PRESIDENT/PRINCIPAL
Credential: MEDICAL DOCTOR
Phone: 661-302-9884