Healthcare Provider Details

I. General information

NPI: 1982718227
Provider Name (Legal Business Name): DENISE ANN JAFFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ROLLING OAKS DR STE 201
THOUSAND OAKS CA
91361-1018
US

IV. Provider business mailing address

135 S STATE COLLEGE BLVD STE 350
BREA CA
92821-5814
US

V. Phone/Fax

Practice location:
  • Phone: 805-719-3700
  • Fax: 805-413-9099
Mailing address:
  • Phone: 805-719-3700
  • Fax: 805-413-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP16045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: