Healthcare Provider Details

I. General information

NPI: 1336325927
Provider Name (Legal Business Name): LINDA I. SODOMA DO PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 E BASELINE RD STE 208
GILBERT AZ
85234-2743
US

IV. Provider business mailing address

4001 E BASELINE RD STE 208
GILBERT AZ
85234-2743
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-4411
  • Fax: 480-776-5169
Mailing address:
  • Phone: 480-668-4411
  • Fax: 480-776-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number3413
License Number StateAZ

VIII. Authorized Official

Name: DR. LINDA I SODOMA
Title or Position: PHYSICIAN OWNER
Credential: D.O.
Phone: 480-668-4411