Healthcare Provider Details

I. General information

NPI: 1336646827
Provider Name (Legal Business Name): BRENDA MARIE SOKUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

970 APPIAN WAY
EL SOBRANTE CA
94803-1106
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-6389
  • Fax:
Mailing address:
  • Phone: 707-534-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number317181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: