Basic Information
| Provider Information | |||||||||
| NPI: | 1215209846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADRAN | ||||||||
| FirstName: | NAWAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12223 HIGHLAND AVE | ||||||||
| Address2: | STE. 106-526 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917392574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146763880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3865 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146763880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2012 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A119387 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A119387 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1215209846 | 05 | CA | MEDICAID |