1336238542 NPI number — H. MICHAEL JAFFIN, M. D., INC

Table of content: (NPI 1336238542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336238542 NPI number — H. MICHAEL JAFFIN, M. D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H. MICHAEL JAFFIN, M. D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
H. MICHAEL JAFFIN, M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336238542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3720 SUNSET LANE
Provider Second Line Business Mailing Address:
SUITE #A
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94509-6124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-706-7788
Provider Business Mailing Address Fax Number:
925-706-7988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 SUNSET LANE
Provider Second Line Business Practice Location Address:
SUITE #A
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94509-6124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-706-7788
Provider Business Practice Location Address Fax Number:
925-706-7988
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAUDENSLAYER
Authorized Official First Name:
AVONA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
925-706-7788

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G30854 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G308540 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".