Provider Demographics
NPI:1639870223
Name:JAFFER, FATIMA G (LAC)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:G
Last Name:JAFFER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 W UNION HILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7001
Mailing Address - Country:US
Mailing Address - Phone:623-977-2304
Mailing Address - Fax:
Practice Address - Street 1:8617 W UNION HILLS DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7001
Practice Address - Country:US
Practice Address - Phone:623-977-2304
Practice Address - Fax:623-242-5755
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist