Healthcare Provider Details

I. General information

NPI: 1871531699
Provider Name (Legal Business Name): RONALD SOCKOLOV M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG480540
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG480540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: