Provider Demographics
NPI:1306057260
Name:LAFOSSE, JOSE MARCOS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARCOS
Last Name:LAFOSSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4251 KIPLING ST
Mailing Address - Street 2:UNIT 565
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2899
Mailing Address - Country:US
Mailing Address - Phone:720-965-0055
Mailing Address - Fax:720-799-0383
Practice Address - Street 1:4080 CENTRE ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2655
Practice Address - Country:US
Practice Address - Phone:858-964-0722
Practice Address - Fax:866-437-0375
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2278103TB0200X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2278OtherSTATE LICENSE