Healthcare Provider Details

I. General information

NPI: 1124288147
Provider Name (Legal Business Name): LINDA BARKODAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 TWEEDY BLVD
SOUTH GATE CA
90280-5538
US

IV. Provider business mailing address

465 N KILKEA DR
LOS ANGELES CA
90048-2228
US

V. Phone/Fax

Practice location:
  • Phone: 323-567-9909
  • Fax:
Mailing address:
  • Phone: 310-422-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA107742
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: