Provider Demographics
NPI:1972218949
Name:BUFORD, MAQUEDA LEYA
Entity type:Individual
Prefix:
First Name:MAQUEDA
Middle Name:LEYA
Last Name:BUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11913 MONTRON WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8241
Mailing Address - Country:US
Mailing Address - Phone:916-410-1385
Mailing Address - Fax:
Practice Address - Street 1:11913 MONTRON WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-8241
Practice Address - Country:US
Practice Address - Phone:916-410-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherN/A