Healthcare Provider Details

I. General information

NPI: 1013141902
Provider Name (Legal Business Name): SOPHIA VANOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 SW 4TH AVE FAMILY MEDICINE
GAINESVILLE FL
32601
US

IV. Provider business mailing address

746 S BECK AVE
TEMPE AZ
85281-3338
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46909
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME112557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: