Provider Demographics
NPI:1427862564
Name:BUFORT, MADELINE MEERIM FRANCESCA
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MEERIM FRANCESCA
Last Name:BUFORT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 SYLVAN RIV UNIT 145
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1347
Mailing Address - Country:US
Mailing Address - Phone:425-516-5118
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4514
Practice Address - Country:US
Practice Address - Phone:171-454-2240
Practice Address - Fax:187-730-6143
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician