Healthcare Provider Details

I. General information

NPI: 1811207384
Provider Name (Legal Business Name): JOSEPHINE BUFALINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSEPHINE BUFALINO LIBAW M.D.

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 S GRAND AVE
PASADENA CA
91105-1623
US

IV. Provider business mailing address

293 S GRAND AVE
PASADENA CA
91105-1623
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG37731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: