Provider Demographics
NPI:1528104858
Name:DANA P. LAUNER, M.D. AND M.JONATHAN WORSEY, M.D, A PROFESSIONAL CORP.
Entity type:Organization
Organization Name:DANA P. LAUNER, M.D. AND M.JONATHAN WORSEY, M.D, A PROFESSIONAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:WORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-558-2272
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-558-2272
Mailing Address - Fax:858-558-2285
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-558-2272
Practice Address - Fax:858-558-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP28993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14681Medicare ID - Type Unspecified