Provider Demographics
NPI:1821043753
Name:SOCKOLOV, ALVIN MARK (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:MARK
Last Name:SOCKOLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1 SCRIPPS DR
Mailing Address - Street 2:#202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6206
Mailing Address - Country:US
Mailing Address - Phone:916-927-1114
Mailing Address - Fax:916-927-3244
Practice Address - Street 1:1 SCRIPPS DR
Practice Address - Street 2:#202
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6206
Practice Address - Country:US
Practice Address - Phone:916-927-1114
Practice Address - Fax:916-927-3244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG455540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G455540Medicare ID - Type Unspecified
CAA50090Medicare UPIN