Provider Demographics
NPI:1356025191
Name:BUFORD, CARL
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BUFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9188
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-9188
Mailing Address - Country:US
Mailing Address - Phone:951-443-6849
Mailing Address - Fax:
Practice Address - Street 1:12997 TAMARA DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4157
Practice Address - Country:US
Practice Address - Phone:951-443-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker