Healthcare Provider Details

I. General information

NPI: 1649333436
Provider Name (Legal Business Name): JASON RIEBEL LEFRINGHOUSE M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-256-4851
  • Fax: 619-532-6587
Mailing address:
  • Phone: 202-256-4851
  • Fax: 619-532-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24932
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46247
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMED-PHYS-LIC-76691
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD-45798
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: