Provider Demographics
NPI:1083902282
Name:BADILLA, JONATHAN MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MAURICIO
Last Name:BADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10250 NORMANDY BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8066
Mailing Address - Country:US
Mailing Address - Phone:904-861-1034
Mailing Address - Fax:904-861-1037
Practice Address - Street 1:10250 NORMANDY BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8066
Practice Address - Country:US
Practice Address - Phone:904-652-0870
Practice Address - Fax:904-652-2308
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140051208000000X
PR20797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics