Healthcare Provider Details

I. General information

NPI: 1073672978
Provider Name (Legal Business Name): SOKO GUSIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W COURT ST #8
PASCO CA
99301
US

IV. Provider business mailing address

PO BOX 1323 515 WEST COURT ST
PASCO CA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-6506
  • Fax: 509-546-0520
Mailing address:
  • Phone: 509-547-2204
  • Fax: 509-542-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00029930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: