Provider Demographics
NPI:1952648727
Name:ZIFFERBLATT, JONATHAN BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BLAIR
Last Name:ZIFFERBLATT
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 1:6246 CALLE VERACRUZ
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6918
Mailing Address - Country:US
Mailing Address - Phone:858-230-1207
Mailing Address - Fax:
Practice Address - Street 1:6246 CALLE VERACRUZ
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6918
Practice Address - Country:US
Practice Address - Phone:858-230-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73596208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice