Provider Demographics
NPI:1457362261
Name:JAMBOOR MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAMBOOR MEDICAL CORPORATION
Other - Org Name:DESERT CITIES DIALYSIS OF BARSTOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ERIAH
Authorized Official - Last Name:SHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-256-3918
Mailing Address - Street 1:655 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3001
Mailing Address - Country:US
Mailing Address - Phone:760-256-3918
Mailing Address - Fax:
Practice Address - Street 1:655 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3001
Practice Address - Country:US
Practice Address - Phone:760-256-3918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000702261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA STATE LICENSEOther240000702
CACA STATE LICENSEOther240000702