Provider Demographics
NPI:1689930570
Name:HEALTHY BABY & ME, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HEALTHY BABY & ME, A MEDICAL CORPORATION
Other - Org Name:HEALTHY BABY & ME CLINICA MEDICA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-204-0909
Mailing Address - Street 1:1666 MEDICAL CENTER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1257
Mailing Address - Country:US
Mailing Address - Phone:909-880-0310
Mailing Address - Fax:909-880-6049
Practice Address - Street 1:1666 MEDICAL CENTER DR STE 3
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1257
Practice Address - Country:US
Practice Address - Phone:909-880-0310
Practice Address - Fax:909-880-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty