Provider Demographics
NPI:1780885053
Name:SOCOL, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SOCOL
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 1:8383 WILSHIRE BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2438
Mailing Address - Country:US
Mailing Address - Phone:310-561-4021
Mailing Address - Fax:213-375-1339
Practice Address - Street 1:8383 WILSHIRE BLVD STE 610
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2438
Practice Address - Country:US
Practice Address - Phone:310-561-4021
Practice Address - Fax:213-375-1339
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061165208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24745Medicare UPIN