Provider Demographics
NPI:1205946985
Name:JAMILA DIABETES & ENDOCRINE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:JAMILA DIABETES & ENDOCRINE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARFRAZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-495-7143
Mailing Address - Street 1:6988 CALLE DIA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8283
Mailing Address - Country:US
Mailing Address - Phone:805-495-7143
Mailing Address - Fax:805-495-7124
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-495-7143
Practice Address - Fax:805-495-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45005207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05226ZOtherBLUE SHIELD
CA00A450050Medicaid
W15897Medicare ID - Type Unspecified
E21812Medicare UPIN