Provider Demographics
NPI:1679078059
Name:DAVIES, SOFIA MANI (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:MANI
Last Name:DAVIES
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:DR
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:MANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MS
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8900
Mailing Address - Fax:
Practice Address - Street 1:1645 BROADWAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6218
Practice Address - Country:US
Practice Address - Phone:303-415-8900
Practice Address - Fax:303-443-6476
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0062933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program