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General NPI Number Information
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NPI Number | 1588999080
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Entity Type | Organization
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Legal Business Name | LEON FAJERMAN
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 5858 MOUNT ALIFAN DR STE 205
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City | SAN DIEGO
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State | CA
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Zip | 92111-2723
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Country | US
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Telephone | 858-565-1177
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Fax | 619-240-7971
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Provider Business Mailing Address
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Address Line | 1642 MELROSE AVE
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City | CHULA VISTA
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State | CA
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Zip | 91911-5915
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Country | US
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Telephone | 858-565-1177
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Fax | 619-240-7971
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Authorized Official
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Title or Position | DOCTOR
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Name | LEON FAJERMAN
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Credential | M.D
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Telephone | 858-565-1177
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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 |
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License Number State |
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