Healthcare Provider Details

I. General information

NPI: 1619029113
Provider Name (Legal Business Name): JEFFRY BEN SCHAFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL SUITE 350
CORONADO CA
92118-1978
US

IV. Provider business mailing address

230 PROSPECT PL SUITE 350
CORONADO CA
92118-1978
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-1388
  • Fax: 619-437-1857
Mailing address:
  • Phone: 619-437-1388
  • Fax: 619-437-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG36897
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG36897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: