Provider Demographics
NPI:1144213067
Name:SOKOL, TERESA BERNADETTE (PA C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:BERNADETTE
Last Name:SOKOL
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12291 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2500
Mailing Address - Country:US
Mailing Address - Phone:562-698-6296
Mailing Address - Fax:562-693-6752
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-698-6296
Practice Address - Fax:562-693-6752
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48881YMedicaid
CA14593OtherSTATE LICENSE
CA14593OtherSTATE LICENSE
CAW1806Medicare ID - Type Unspecified