Healthcare Provider Details

I. General information

NPI: 1205875663
Provider Name (Legal Business Name): SOCKOLOV & SOCKOLOV A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCRIPPS DR 202
SACRAMENTO CA
95825-6206
US

IV. Provider business mailing address

1 SCRIPPS DR 202
SACRAMENTO CA
95825-6206
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1114
  • Fax: 916-927-3244
Mailing address:
  • Phone: 916-927-1114
  • Fax: 916-927-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD SOCKOLOV
Title or Position: OWNER
Credential: M.D
Phone: 916-927-1114