| Senior Doc Wisconsin SC | |
|
2592 N Santiago Blvd Orange CA 92867-1862 | |
| (855) 434-7763 | |
| Not Available |
| Full Name | Senior Doc Wisconsin SC |
|---|---|
| Speciality | Family Medicine |
| Location | 2592 N Santiago Blvd, Orange, California |
| Authorized Official Name and Position | Angelica Contact (CREDENTIALING) |
| 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 Wisconsin SC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 | Senior Doc Wisconsin SC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 |
| NPI Number | 1932954260 |
|---|---|
| Provider Enumeration Date | 04/19/2024 |
| Last Update Date | 10/11/2024 |
| Certification Date | 10/11/2024 |
| Medicare PECOS PAC ID | 9739670027 |
|---|---|
| Medicare Enrollment ID | O20251114001044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932954260 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Cassie Kaur Dundon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831685395 PECOS PAC ID: 5092057661 Enrollment ID: I20190430003096 |
| Provider Name | John Geiss |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1053651497 PECOS PAC ID: 5890933071 Enrollment ID: I20240920001888 |
| Provider Name | Jeffrey John Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932337136 PECOS PAC ID: 7315101003 Enrollment ID: I20240926003698 |
| Provider Name | Meredith Alexandra Bock |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447612940 PECOS PAC ID: 8729339908 Enrollment ID: I20260318001344 |
| Provider Name | Peris Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861292443 PECOS PAC ID: 4284146655 Enrollment ID: I20260409003802 |
| Provider Name | Rachelle Marie Virgin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578341913 PECOS PAC ID: 9234588062 Enrollment ID: I20260601000431 |
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