Healthcare Provider Details

I. General information

NPI: 1821008350
Provider Name (Legal Business Name): CHRISTOPHER MARK LAFFERTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

IV. Provider business mailing address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2702
  • Fax: 619-644-1139
Mailing address:
  • Phone: 858-499-2702
  • Fax: 619-644-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG59603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: