| Lawrence J Jaffe Md A Medical Corporation | |
|
4411 Morena Blvd Suite 230 San Diego CA 92117-4328 | |
| (619) 233-1616 | |
| Not Available |
| Full Name | Lawrence J Jaffe Md A Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4411 Morena Blvd, San Diego, California |
| Authorized Official Name and Position | Lawrence Jay Jaffe (PRESIDENT/OWNER) |
| Authorized Official Contact | 6192331616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence J Jaffe Md A Medical Corporation Po Box 1770 La Mesa CA 91944-1770 Ph: (619) 233-1616 | Lawrence J Jaffe Md A Medical Corporation 4411 Morena Blvd Suite 230 San Diego CA 92117-4328 Ph: (619) 233-1616 |
| NPI Number | 1265470694 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 07/15/2022 |
| Certification Date | 07/15/2022 |
| Medicare PECOS PAC ID | 3173526936 |
|---|---|
| Medicare Enrollment ID | O20060816000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265470694 | NPI | - | NPPES |
| 00A322740 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A32274 (California) | Primary |
| Provider Name | Lawrence J Jaffe |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1225072903 PECOS PAC ID: 4183627946 Enrollment ID: I20060816000308 |
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