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General NPI Number Information
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NPI Number | 1265470694
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Entity Type | Organization
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Legal Business Name | LAWRENCE J JAFFE MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 4411 MORENA BLVD SUITE 230
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City | SAN DIEGO
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State | CA
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Zip | 92117-4328
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Country | US
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Telephone | 619-233-1616
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-233-1616
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LAWRENCE JAY JAFFE
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Credential | M.D.
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Telephone | 619-233-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A32274
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License Number State | CA
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