Individual
JAY SHANKER AGARWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 E HIGHLAND AVE, SUITE 551, SAN BERNARDINO, CA 92404-3803
(909) 882-9150
(909) 883-8972
Mailing address
PO BOX 54130, LOS ANGELES, CA 90054-0130
(951) 687-3400
(951) 687-7630
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A78358
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A783580
—
CA
Enumeration date
05/18/2006
Last updated
12/26/2012
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