Provider Demographics
NPI:1053347450
Name:JOHN A LA FATA MD INC
Entity type:Organization
Organization Name:JOHN A LA FATA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANNE BILLETER PRACTICE ADMINISTRATO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LA FATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-726-2180
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-726-2180
Mailing Address - Fax:760-726-9928
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-726-2180
Practice Address - Fax:760-726-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG329870Medicaid
CAOOG329870Medicaid
CAA45375Medicare UPIN