Provider Demographics
NPI:1457530479
Name:FAMILY WELLNESS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FAMILY WELLNESS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:ADEGBITE
Authorized Official - Last Name:JUMADU
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:909-886-8420
Mailing Address - Street 1:1909 S WATERMAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-886-8420
Mailing Address - Fax:909-886-8409
Practice Address - Street 1:1909 S WATERMAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-886-8420
Practice Address - Fax:909-886-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC387122080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty