Provider Demographics
NPI:1417081274
Name:JAFFE, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MIRAMONTES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 MIRAMONTES ST STE 202
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1942
Practice Address - Country:US
Practice Address - Phone:650-889-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA886232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91891ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAFHC 70042FOtherCOUNTY OF SANTA CRUZ MEDI-CAL GROUP#
CAZZZ91892ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAFHC 70044FOtherCOUNTY OF SANTA CRUZ MEDI-CAL GROUP#
CAZZZ92069ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#