Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G86528 | CA |
NPI | 1023352143 |
---|---|
Provider Name | Dr. Robert Torin Jaffe |
First Address | Santa Rosa, CA 95403-0000 |
Second Address | Santa Rosa, CA 95403-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |