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General NPI Number Information
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NPI Number | 1902993256
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Entity Type | Organization
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Legal Business Name | M BADR MD INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 703 W GRAHAM AVE 101
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-3514
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Country | US
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Telephone | 760-768-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 703 W GRAHAM AVE 101
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-3514
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Country | US
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Telephone | 760-768-6800
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Fax | 760-768-6886
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED BADR
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Credential | MD
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Telephone | 760-768-6800
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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 | A56397
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License Number State | CA
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