Provider Demographics
NPI:1053048850
Name:DAIRI, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:DAIRI
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 1:3329 BARNES CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1165
Mailing Address - Country:US
Mailing Address - Phone:818-641-0200
Mailing Address - Fax:
Practice Address - Street 1:3329 BARNES CIR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1165
Practice Address - Country:US
Practice Address - Phone:818-641-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant