MEDICARE: THERESA ANN SOFARELLI P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	290142-1206	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00417316	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972693505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ANN SOFARELLI P.A.-C

Provider Business Mailing Address
First Line	:	3901 23RD ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3302
Country	:	US
Telephone Number	:	415-830-4744
Fax Number	:	415-291-0489

Provider Business Practice Location Address
First Line	:	3901 23RD ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3302
Country	:	US
Telephone Number	:	415-830-4744
Fax Number	:	415-291-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/17/2021

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Directions to “ THERESA ANN SOFARELLI P.A.-C” Practice Location

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