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General NPI Number Information
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NPI Number | 1457530479
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 1909 S WATERMAN AVE SUITE 3
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-886-8420
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Fax | 909-886-8409
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Provider Business Mailing Address
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Address Line | 1909 S WATERMAN AVE SUITE 3
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-886-8420
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Fax | 909-886-8409
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Authorized Official
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Title or Position | PRESIDENT/PRINCIPAL
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Name | DR. BABATUNDE ADEGBITE JUMADU
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Credential | MEDICAL DOCTOR
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Telephone | 909-886-8420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | C38712
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License Number State | CA
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