Provider Demographics
NPI:1548449564
Name:FAMILY WELLNESS MEDICAL CORPORATION
Entity type:Organization
Organization Name:FAMILY WELLNESS MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
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:JINADU
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:661-302-9884
Mailing Address - Street 1:190 AVENIDA ALTAMIRA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4602
Mailing Address - Country:US
Mailing Address - Phone:619-338-0787
Mailing Address - Fax:619-338-0782
Practice Address - Street 1:3582 NATIONAL AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3157
Practice Address - Country:US
Practice Address - Phone:619-338-0787
Practice Address - Fax:619-338-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0387212080A0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty