Healthcare Provider Details

I. General information

NPI: 1770542292
Provider Name (Legal Business Name): HELEN R. JAFFA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 E CULVER ST
MESA AZ
85207-1051
US

IV. Provider business mailing address

7011 E CULVER ST
MESA AZ
85207-1051
US

V. Phone/Fax

Practice location:
  • Phone: 480-924-5995
  • Fax: 480-924-5860
Mailing address:
  • Phone: 480-924-5995
  • Fax: 480-924-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAZ0143490
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerBCBSOF AZ PIN

VIII. Authorized Official

Name: HELEN R JAFFA
Title or Position: PRESIDENT
Credential:
Phone: 480-924-5995