MEDICARE: DR. CHARLES JAFFE MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	C37310	CA

General Provider Information

NPI Number	:	1114259827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JAFFE MD, PHD

Provider Business Mailing Address
First Line	:	1619 FOREST WAY
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2430
Country	:	US
Telephone Number	:	858-720-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 FOREST WAY
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2430
Country	:	US
Telephone Number	:	858-720-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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