Healthcare Provider Details

I. General information

NPI: 1316337512
Provider Name (Legal Business Name): SODEGA, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8846 ROOSEVELT BLVD
PHILADELPHIA PA
19115-5003
US

IV. Provider business mailing address

8846 ROOSEVELT BLVD
PHILADELPHIA PA
19115-5003
US

V. Phone/Fax

Practice location:
  • Phone: 267-474-5307
  • Fax:
Mailing address:
  • Phone: 267-474-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License NumberNONE
License Number StatePA

VIII. Authorized Official

Name: ERIK MCENTYRE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 267-474-5307