| Doctor Name: | DR. MICHAEL JAFFE |
| NPI Number: | 1275703290 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A25723 |
| Business Practice Address: | 100 Prison Rd Represa, CA - 956713000 |
| Business Phone Number: | 9162943174 |
| Business Fax Number: | 9162943956 |
| Mailing Address: | 100 Prison Rd, REPRESA |
| State: | CA |
| Postal Code: | 956713000 |
| Phone Number: | 9162943174 |
| Fax Number: | 9162943056 |
| NPI Enumeration Date: | 03/05/2008 |
| NPI Last Update Date: | 03/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A25723 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |