Provider Demographics
NPI:1811207384
Name:BUFALINO, JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:BUFALINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JOSEPHINE
Other - Middle Name:BUFALINO
Other - Last Name:LIBAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:293 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:293 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1623
Practice Address - Country:US
Practice Address - Phone:626-792-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37731207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49918Medicare UPIN