Provider Demographics
NPI:1285662403
Name:LAFATA, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LAFATA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-726-2180
Mailing Address - Fax:760-726-9928
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-726-2180
Practice Address - Fax:760-726-9928
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-04-01
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Provider Licenses
StateLicense IDTaxonomies
CAG32987207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG329870Medicaid
CAOOG329870Medicaid
CAA45375Medicare UPIN