Provider Demographics
NPI:1205875663
Name:SOCKOLOV & SOCKOLOV A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SOCKOLOV & SOCKOLOV A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCKOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-927-1114
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05281ZMedicare UPIN