Provider Demographics
NPI:1508605502
Name:BUFFINI, SOPHIA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:BUFFINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MARIE
Other - Last Name:OLMSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16516 BERNARDO CENTER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2551
Mailing Address - Country:US
Mailing Address - Phone:858-336-2810
Mailing Address - Fax:949-798-7990
Practice Address - Street 1:16516 BERNARDO CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2549
Practice Address - Country:US
Practice Address - Phone:858-336-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA64476363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant