Basic Information
| Provider Information | |||||||||
| NPI: | 1922272053 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SJ&J MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3130 N ARIZONA AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852257163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802928579 | ||||||||
| FaxNumber: | 4803066029 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 N ARIZONA AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852257163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802928579 | ||||||||
| FaxNumber: | 4803066029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2008 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | JABATI | ||||||||
| AuthorizedOfficialFirstName: | SALLU | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4802928579 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.