Basic Information
| Provider Information | |||||||||
| NPI: | 1780772376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JADALLAH | ||||||||
| FirstName: | ADIL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 877 RALSTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505937643 | ||||||||
| FaxNumber: | 6505934497 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 SHOREWAY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940024151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505967000 | ||||||||
| FaxNumber: | 6505967093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A20855 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.