Healthcare Provider Details

I. General information

NPI: 1992116263
Provider Name (Legal Business Name): MICHAEL LAJIN, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR STE 330
LA MESA CA
91942-7001
US

IV. Provider business mailing address

8860 CENTER DR STE 330
LA MESA CA
91942-7001
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 TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC53475
License Number StateCA

VIII. Authorized Official

Name: KATHERINE HENDRICKSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-312-1562