Provider Demographics
NPI:1063501468
Name:SOFIO, CAROLE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANN
Last Name:SOFIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:
Other - Last Name:SOFIO MALCHOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1310 W. STEWART DR.
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3857
Mailing Address - Country:US
Mailing Address - Phone:714-639-0414
Mailing Address - Fax:714-639-3313
Practice Address - Street 1:1310 W. STEWART DR.
Practice Address - Street 2:SUITE 602
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3857
Practice Address - Country:US
Practice Address - Phone:714-639-0414
Practice Address - Fax:714-639-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E02797Medicare UPIN
CABP313ZMedicare PIN
CABP313YMedicare PIN