Provider Demographics
NPI:1225643448
Name:JED PADRE MD INC
Entity Type:Organization
Organization Name:JED PADRE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-518-6861
Mailing Address - Street 1:282 E SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6323
Mailing Address - Country:US
Mailing Address - Phone:310-518-6861
Mailing Address - Fax:310-835-1366
Practice Address - Street 1:282 E SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6323
Practice Address - Country:US
Practice Address - Phone:310-518-6861
Practice Address - Fax:310-835-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty