MEDICARE: SOFIA DAIRI

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

General Provider Information

NPI Number	:	1053048850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA DAIRI

Provider Business Mailing Address
First Line	:	3329 BARNES CIR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1165
Country	:	US
Telephone Number	:	818-641-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 BARNES CIR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1165
Country	:	US
Telephone Number	:	818-641-0200
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “ SOFIA DAIRI ” Practice Location

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