MEDICARE: GREGORY GEORGE SOKOLOV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	A63076	CA
2	2084P0800X	Psychiatry Physician	A63076	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891778890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY GEORGE SOKOLOV M.D.

Provider Business Mailing Address
First Line	:	1601 CUMMINS DR STE D
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95358-6411
Country	:	US
Telephone Number	:	510-900-3125
Fax Number	:	510-879-4077

Provider Business Practice Location Address
First Line	:	1325 COTTONWOOD ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-5131
Country	:	US
Telephone Number	:	530-662-3961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/22/2021

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