| Sofia R Bulahan, FNP | |
|
Copperopolis Family Medical Clinic, 3505 Spangler Lane, Suite 400, Copperopolis, CA 95228 | |
| (209) 785-7000 | |
| Not Available |
| Full Name | Sofia R Bulahan |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | Copperopolis Family Medical Clinic, Copperopolis, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760610497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 17924-N (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Sofia R Bulahan, FNP Mark Twain Medical Center, 768 Mountain Ranch Road, San Andreas, CA 95249 Ph: (209) 754-3521 | Sofia R Bulahan, FNP Copperopolis Family Medical Clinic, 3505 Spangler Lane, Suite 400, Copperopolis, CA 95228 Ph: (209) 785-7000 |
Pennie Khong, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3505 Spangler Ln Ste 400, Copperopolis, CA 95228 Phone: 209-785-7000 | |
Polly Chrysanthemum Dodds, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 430 Sawmill Creek Rd Unit 6, Copperopolis, CA 95228 Phone: 209-785-7000 Fax: 209-785-7025 |