Provider Demographics
NPI:1407868797
Name:SOMOZA, MELINDA FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:FAYE
Last Name:SOMOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:BOWMAN
Other - Last Name:SOMOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:840 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4232
Mailing Address - Country:US
Mailing Address - Phone:740-353-3236
Mailing Address - Fax:740-353-4803
Practice Address - Street 1:840 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4232
Practice Address - Country:US
Practice Address - Phone:740-353-3236
Practice Address - Fax:740-353-4803
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ837817Medicaid
AZH59461Medicare UPIN
AZ837817Medicaid
AZ8HE308Medicare ID - Type UnspecifiedPROVIDER NO.