Healthcare Provider Details

I. General information

NPI: 1407044787
Provider Name (Legal Business Name): JACOB RAJFER M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

FILE 2939
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-6204
  • Fax:
Mailing address:
  • Phone: 310-301-8709
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB RAJFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-301-8709