MEDICARE: SOPHIA MARIE BUFFINI PA-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
2	363AM0700X	Medical Physician Assistant	64476	CA

General Provider Information

NPI Number	:	1508605502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MARIE BUFFINI PA-C

Provider Business Mailing Address
First Line	:	16516 BERNARDO CENTER DR STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2551
Country	:	US
Telephone Number	:	858-336-2810
Fax Number	:	949-798-7990

Provider Business Practice Location Address
First Line	:	16516 BERNARDO CENTER DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2549
Country	:	US
Telephone Number	:	858-336-2810
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/19/2026

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