Provider Demographics
NPI:1689907461
Name:BADLANI, POOJA MAHAJAN (MBBS)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:MAHAJAN
Last Name:BADLANI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-835-7946
Mailing Address - Fax:909-363-7447
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-835-7946
Practice Address - Fax:909-363-7447
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117250207RN0300X
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No282N00000XHospitalsGeneral Acute Care Hospital