| Senior Doc Az Medical PC | |
|
2592 N Santiago Blvd Orange CA 92867-1862 | |
| (855) 434-7763 | |
| (949) 281-5550 |
| Full Name | Senior Doc Az Medical PC |
|---|---|
| Speciality | Family Medicine |
| Location | 2592 N Santiago Blvd, Orange, California |
| Authorized Official Name and Position | John M Geiss (CEO) |
| Authorized Official Contact | 8554347763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Doc Az Medical PC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 | Senior Doc Az Medical PC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 |
| NPI Number | 1790550895 |
|---|---|
| Provider Enumeration Date | 11/17/2023 |
| Last Update Date | 11/17/2023 |
| Certification Date | 11/17/2023 |
| Medicare PECOS PAC ID | 1254771124 |
|---|---|
| Medicare Enrollment ID | O20240425004153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790550895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Catherine Lynette Lacourt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942232988 PECOS PAC ID: 8123080637 Enrollment ID: I20050923000304 |
| Provider Name | Russell G Forsberg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407039910 PECOS PAC ID: 7810077039 Enrollment ID: I20071231000085 |
| Provider Name | Melissa J Claudio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639377518 PECOS PAC ID: 2163504275 Enrollment ID: I20080129000283 |
| Provider Name | Byron K Grayson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346299021 PECOS PAC ID: 4183516834 Enrollment ID: I20130314000393 |
| Provider Name | Kirby R Farnsworth |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124464839 PECOS PAC ID: 4385948355 Enrollment ID: I20160829000906 |
| Provider Name | Nicole Barth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417497066 PECOS PAC ID: 0042576175 Enrollment ID: I20171106003166 |
| Provider Name | Dumebi Uchendu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558870378 PECOS PAC ID: 0941568240 Enrollment ID: I20171214000901 |
| Provider Name | Myungran Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639687684 PECOS PAC ID: 8921358086 Enrollment ID: I20180911001913 |
| Provider Name | Nicole Marie Musabelliu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457772311 PECOS PAC ID: 8628297900 Enrollment ID: I20191025001818 |
| Provider Name | Eunmee Chung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255981593 PECOS PAC ID: 0749613065 Enrollment ID: I20191127000654 |
| Provider Name | Renee Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952946071 PECOS PAC ID: 6002242351 Enrollment ID: I20200204002016 |
| Provider Name | Renee Marie Rundle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457990913 PECOS PAC ID: 6204262033 Enrollment ID: I20200214000235 |
| Provider Name | Andrea Tuthill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144777434 PECOS PAC ID: 0547543126 Enrollment ID: I20200527002136 |
| Provider Name | Derek Gene Dicamillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972105542 PECOS PAC ID: 4183035900 Enrollment ID: I20201201000660 |
| Provider Name | John Geiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053651497 PECOS PAC ID: 5890933071 Enrollment ID: I20211104002956 |
| Provider Name | Mikaela Ariel Deans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366109746 PECOS PAC ID: 1153715586 Enrollment ID: I20220301002589 |
| Provider Name | Micah Ruben Ruybalid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619695277 PECOS PAC ID: 7911370127 Enrollment ID: I20230308001468 |
| Provider Name | Christina Wohlforth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770363533 PECOS PAC ID: 6103272711 Enrollment ID: I20231101003663 |
| Provider Name | Kari Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568159226 PECOS PAC ID: 0345697330 Enrollment ID: I20231113003350 |
| Provider Name | Cynthia Jean Villa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639874852 PECOS PAC ID: 4284083080 Enrollment ID: I20231205002749 |
| Provider Name | Jeffrey John Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932337136 PECOS PAC ID: 7315101003 Enrollment ID: I20240416002272 |
| Provider Name | Teryn Lies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558141796 PECOS PAC ID: 0446691067 Enrollment ID: I20240514003389 |
| Provider Name | Anthony Marcus Yniguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871185686 PECOS PAC ID: 2769882331 Enrollment ID: I20240625003470 |
| Provider Name | Alexi Yarashevich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306340831 PECOS PAC ID: 6406119304 Enrollment ID: I20240626002795 |
| Provider Name | Daniel John Konchan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356047542 PECOS PAC ID: 9931572302 Enrollment ID: I20240722003579 |
| Provider Name | Sarah Kelley Lockwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972193217 PECOS PAC ID: 1052725249 Enrollment ID: I20240925000002 |
| Provider Name | Cassie Kaur Dundon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831685395 PECOS PAC ID: 5092057661 Enrollment ID: I20260216002588 |
| Provider Name | Stella Yufenyuy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528890472 PECOS PAC ID: 2567903016 Enrollment ID: I20260217001421 |
| Provider Name | Henriette Solyst Hvingelby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942353107 PECOS PAC ID: 2668570979 Enrollment ID: I20260218003358 |
| Provider Name | Meredith Alexandra Bock |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447612940 PECOS PAC ID: 8729339908 Enrollment ID: I20260220001082 |
| Provider Name | Nicole Frankle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467729525 PECOS PAC ID: 5496013716 Enrollment ID: I20260318003096 |
| Provider Name | Robert Charles Morse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356194005 PECOS PAC ID: 0143766287 Enrollment ID: I20260429004270 |
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