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General NPI Number Information
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NPI Number | 1457362261
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Entity Type | Organization
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Legal Business Name | JAMBOOR MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 655 S 7TH AVE
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City | BARSTOW
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State | CA
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Zip | 92311-3001
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Country | US
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Telephone | 760-256-3918
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S 7TH AVE
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City | BARSTOW
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State | CA
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Zip | 92311-3001
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Country | US
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Telephone | 760-256-3918
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Fax |
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | JAY ERIAH SHANKAR
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Credential | M.D.
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Telephone | 760-256-3918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 240000702
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License Number State | CA
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