Basic Information
| Provider Information | |||||||||
| NPI: | 1083902282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADILLA | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | MAURICIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1978 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320501978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048611034 | ||||||||
| FaxNumber: | 9048611037 | ||||||||
| Practice Location | |||||||||
| Address1: | 10250 NORMANDY BLVD UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322218066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046520870 | ||||||||
| FaxNumber: | 9046522308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME140051 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 20797 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.