| Organization Name: | JAMBOOR MEDICAL CORPORATION |
| NPI Number: | 1063421212 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAY ERIAH SHANKAR (OWNER) |
| Mailing Address: | 12675 Hesperia Rd Victorville |
| State: | CA US |
| Postal Code: | 923955878 |
| Phone Number: | 7602418063 |
| Fax Number: | 7602415037 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 04/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 240000431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |