Healthcare Provider Details

I. General information

NPI: 1710963509
Provider Name (Legal Business Name): DAVID ALLAN LIFSET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/07/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE ATTN: OB/GYN DEPT
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

514 VERBENA CT
ENCINITAS CA
92024-2385
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-4015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA80599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: