Provider Demographics
NPI:1184665937
Name:SOKOLOFF, RONALD M (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:SOKOLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13518 WILLOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1734
Mailing Address - Country:US
Mailing Address - Phone:619-379-8697
Mailing Address - Fax:
Practice Address - Street 1:13518 WILLOW RUN RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-1734
Practice Address - Country:US
Practice Address - Phone:619-379-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG665372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G665370Medicaid
CA00G665370Medicaid
CAF81256Medicare UPIN