Provider Demographics
NPI:1922038256
Name:ALLERGY AND RHEUMATOLOGY MEDICAL CLINIC., INC
Entity Type:Organization
Organization Name:ALLERGY AND RHEUMATOLOGY MEDICAL CLINIC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-457-3270
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-457-3270
Mailing Address - Fax:858-457-5723
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-457-3270
Practice Address - Fax:858-457-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25563174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2819Medicare ID - Type Unspecified
CAA24494Medicare UPIN