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General NPI Number Information
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NPI Number | 1023171501
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Entity Type | Individual
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Provider Name | AMER A JANDALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 23110 ATLANTIC CIR SUITE A
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5920
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Country | US
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Telephone | 951-243-9885
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Fax | 951-243-8126
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Provider Business Mailing Address
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Address Line | PO BOX 7419
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City | MORENO VALLEY
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State | CA
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Zip | 92552-7419
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Country | US
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Telephone | 951-243-9885
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Fax | 951-243-8126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A49316
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License Number State | CA
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