Provider Demographics
NPI:1669448577
Name:SODOMA, LINDA IVANA (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:IVANA
Last Name:SODOMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 E BASELINE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2743
Mailing Address - Country:US
Mailing Address - Phone:480-668-4411
Mailing Address - Fax:480-776-5169
Practice Address - Street 1:4001 E BASELINE RD STE 208
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2743
Practice Address - Country:US
Practice Address - Phone:480-668-4411
Practice Address - Fax:480-776-5169
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ470386Medicaid
AZ72768Medicare ID - Type Unspecified
AZ470386Medicaid