| Senior Doc New Jersey PC | |
|
5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 | |
| (714) 702-5145 | |
| (949) 281-5550 |
| Full Name | Senior Doc New Jersey PC |
|---|---|
| Speciality | Family Medicine |
| Location | 5 Hutton Centre Dr Ste 950, Santa Ana, California |
| Authorized Official Name and Position | Angelica L Soto (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7147025145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Doc New Jersey PC 5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 Ph: (714) 702-5145 | Senior Doc New Jersey PC 5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 Ph: (714) 702-5145 |
| NPI Number | 1700610094 |
|---|---|
| Provider Enumeration Date | 08/28/2024 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Medicare PECOS PAC ID | 9133652688 |
|---|---|
| Medicare Enrollment ID | O20241101002392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700610094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Jeffrey John Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932337136 PECOS PAC ID: 7315101003 Enrollment ID: I20241007000832 |
| Provider Name | Kellie Marie Pacheco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326728668 PECOS PAC ID: 1951756519 Enrollment ID: I20260128000571 |
| Provider Name | Meredith Alexandra Bock |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447612940 PECOS PAC ID: 8729339908 Enrollment ID: I20260507001781 |
| Provider Name | Christine M. Padilla |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386897262 PECOS PAC ID: 6305991670 Enrollment ID: I20260609001652 |
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