Healthcare Provider Details

I. General information

NPI: 1679078059
Provider Name (Legal Business Name): SOFIA MANI DAVIES DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOFIA MANI DO, MS

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 BROADWAY
BOULDER CO
80302-6218
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-8900
  • Fax: 303-443-6476
Mailing address:
  • Phone: 303-415-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0062933
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: