1427862564 NPI number — MADELINE MEERIM FRANCESCA BUFORT

Table of content: MADELINE MEERIM FRANCESCA BUFORT (NPI 1427862564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427862564 NPI number — MADELINE MEERIM FRANCESCA BUFORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUFORT
Provider First Name:
MADELINE
Provider Middle Name:
MEERIM FRANCESCA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427862564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12143 SYLVAN RIV UNIT 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-516-5118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S MAIN ST STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-454-2240
Provider Business Practice Location Address Fax Number:
187-730-6143
Provider Enumeration Date:
02/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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