Provider Demographics
NPI:1598833907
Name:BOUFFARD, ELAINE SUZANNE
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:SUZANNE
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 SAN ANTONIO PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1605
Mailing Address - Country:US
Mailing Address - Phone:408-280-2635
Mailing Address - Fax:
Practice Address - Street 1:1210 S BASCOM AVE STE 224
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3535
Practice Address - Country:US
Practice Address - Phone:408-280-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41956OtherUNICARE