Basic Information
| Provider Information | |||||||||
| NPI: | 1013951870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BADDAY | ||||||||
| FirstName: | JALAL | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1060 E FOOTHILL BLVD | ||||||||
| Address2: | 201 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099828044 | ||||||||
| FaxNumber: | 9099820144 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 E FOOTHILL BLVD | ||||||||
| Address2: | 201 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099828044 | ||||||||
| FaxNumber: | 9099820144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C42224 | CA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00C422240 | 01 | CA | MEDI-CAL | OTHER |