| Senior Doc Indiana Pc | |
|
5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 | |
| (855) 434-7763 | |
| (949) 281-5550 |
| Full Name | Senior Doc Indiana Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 5 Hutton Centre Dr Ste 950, Santa Ana, California |
| Authorized Official Name and Position | Angelica Leyla Soto (CREDENTIALING SPECIALIST) |
| 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 Indiana Pc 5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 Ph: (855) 434-7763 | Senior Doc Indiana Pc 5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8714 Ph: (855) 434-7763 |
| NPI Number | 1710748397 |
|---|---|
| Provider Enumeration Date | 01/19/2024 |
| Last Update Date | 12/09/2024 |
| Medicare PECOS PAC ID | 2466897848 |
|---|---|
| Medicare Enrollment ID | O20240226000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710748397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | John Mark Geiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053651497 PECOS PAC ID: 5890933071 Enrollment ID: I20240313000359 |
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