Healthcare Provider Details

I. General information

NPI: 1467411702
Provider Name (Legal Business Name): MICHAEL LAJIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 330
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR SUITE 330
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-4055
  • Fax: 619-460-5148
Mailing address:
  • Phone: 619-460-4055
  • Fax: 619-460-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301071757
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC53475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: