Provider Demographics
NPI:1750580940
Name:JAMES MCCAFFERY MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:JAMES MCCAFFERY MD A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SORGANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-956-1010
Mailing Address - Street 1:14124 FOOTHILL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8049
Mailing Address - Country:US
Mailing Address - Phone:818-364-8181
Mailing Address - Fax:818-364-8185
Practice Address - Street 1:14124 FOOTHILL BOULEVARD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-8049
Practice Address - Country:US
Practice Address - Phone:818-364-8181
Practice Address - Fax:818-364-8185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES MCCAFFERY MD A MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098290Medicaid
CAGSD004670Medicaid
CAZZZ75843Z CAMedicaid
CAZZZ75843Z CAMedicaid