Provider Demographics
NPI:1063791242
Name:SOKOLOFF, RANDALL JAY
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:JAY
Last Name:SOKOLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-7332
Mailing Address - Country:US
Mailing Address - Phone:510-388-1117
Mailing Address - Fax:
Practice Address - Street 1:3663 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-7062
Practice Address - Country:US
Practice Address - Phone:925-449-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health