Provider Demographics
NPI:1366471096
Name:JAIBAJI, MONEER (MD)
Entity Type:Individual
Prefix:
First Name:MONEER
Middle Name:
Last Name:JAIBAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MONEER
Other - Middle Name:
Other - Last Name:JAIBAJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2957
Mailing Address - Street 2:MONEER JAIBAJI
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2957
Mailing Address - Country:US
Mailing Address - Phone:619-522-0821
Mailing Address - Fax:619-522-0808
Practice Address - Street 1:8851 CENTER DRIVE
Practice Address - Street 2:SUITE # 301
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3058
Practice Address - Country:US
Practice Address - Phone:619-522-0821
Practice Address - Fax:619-522-0808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94261208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY
H77873Medicare UPIN
CAA94261Medicare PIN