Provider Demographics
NPI:1336238542
Name:H. MICHAEL JAFFIN, M. D., INC
Entity Type:Organization
Organization Name:H. MICHAEL JAFFIN, M. D., INC
Other - Org Name:H. MICHAEL JAFFIN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVONA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAUDENSLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-706-7788
Mailing Address - Street 1:3720 SUNSET LANE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6124
Mailing Address - Country:US
Mailing Address - Phone:925-706-7788
Mailing Address - Fax:925-706-7988
Practice Address - Street 1:3720 SUNSET LANE
Practice Address - Street 2:SUITE #A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6124
Practice Address - Country:US
Practice Address - Phone:925-706-7788
Practice Address - Fax:925-706-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G308540OtherMEDICARE ID
CA00G308540OtherMEDICARE ID