Provider Demographics
NPI:1427338946
Name:BUFETE, JESSICA ANNE MADDOX (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE MADDOX
Last Name:BUFETE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 SAWTELLE BLVD
Mailing Address - Street 2:APT 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1663
Mailing Address - Country:US
Mailing Address - Phone:559-960-8009
Mailing Address - Fax:
Practice Address - Street 1:3283 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3709
Practice Address - Country:US
Practice Address - Phone:310-845-9690
Practice Address - Fax:310-845-9691
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist