Provider Demographics
NPI:1265609119
Name:JIFFRY MEDICAL CORPORATION
Entity type:Organization
Organization Name:JIFFRY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHAMED
Authorized Official - Middle Name:J
Authorized Official - Last Name:JIFFRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-8227
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-886-8227
Mailing Address - Fax:909-883-3358
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-886-8227
Practice Address - Fax:909-883-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A35010Medicaid
CAZZZ07670ZMedicare PIN
CAA29703Medicare UPIN