Provider Demographics
NPI:1972693505
Name:SOFARELLI, THERESA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:SOFARELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:SOFARELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3901 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3302
Mailing Address - Country:US
Mailing Address - Phone:415-830-4744
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:3901 23RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3302
Practice Address - Country:US
Practice Address - Phone:415-830-4744
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290142-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00417316OtherRAILROAD MEDICARE
ID806795900Medicaid
ID806795900Medicaid
UT000060974Medicare PIN
UTP00417316OtherRAILROAD MEDICARE