Individual
GINA RIVERA SOKOLICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
930 KEHRS MILL RD STE 325-13, BALLWIN, MO 63011-2403
(314) 775-1623
Mailing address
930 KEHRS MILL RD, BALLWIN, MO 63011-2462
(314) 775-1623
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0000000000
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6624
PRIVATE PAY
MO
Enumeration date
12/28/2019
Last updated
12/28/2019
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