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General NPI Number Information
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NPI Number | 1699870139
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Entity Type | Individual
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Provider Name | BADRAN MADANI MD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 952 S MOUNT VERNON AVE SUITE B
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City | COLTON
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State | CA
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Zip | 92324-4218
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Country | US
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Telephone | 909-886-3660
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Fax | 909-824-2906
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Provider Business Mailing Address
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Address Line | 952 SOUTH MOUNT VERNON AVE SUITE B
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-886-3660
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Fax | 909-824-2906
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A66356
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License Number State | CA
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