Healthcare Provider Details

I. General information

NPI: 1003683780
Provider Name (Legal Business Name): GENNADY SOKOLSKY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823-2329
US

IV. Provider business mailing address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823-2329
US

V. Phone/Fax

Practice location:
  • Phone: 916-288-0300
  • Fax:
Mailing address:
  • Phone: 916-288-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number604440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: