Senior Medical Associates, Inc. | |
2810 Camino Del Rio S Ste 102 San Diego CA 92108-3818 | |
(858) 385-1419 | |
(858) 461-6008 |
Full Name | Senior Medical Associates, Inc. |
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Speciality | Internal Medicine |
Location | 2810 Camino Del Rio S, San Diego, California |
Authorized Official Name and Position | Jason S Keri (PRESIDENT) |
Authorized Official Contact | 6192991419 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Senior Medical Associates, Inc. 2810 Camino Del Rio S Ste 102 San Diego CA 92108-3818 Ph: (619) 299-1419 | Senior Medical Associates, Inc. 2810 Camino Del Rio S Ste 102 San Diego CA 92108-3818 Ph: (858) 385-1419 |
NPI Number | 1629253505 |
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Provider Enumeration Date | 01/09/2008 |
Last Update Date | 12/18/2014 |
Medicare PECOS PAC ID | 0446339469 |
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Medicare Enrollment ID | O20080501000744 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629253505 | NPI | - | NPPES |
Provider Name | Matthew D Dickson |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1457388720 PECOS PAC ID: 9133019565 Enrollment ID: I20040318000625 |
Provider Name | Ellen Elizabeth Edwards |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1245332923 PECOS PAC ID: 9234121682 Enrollment ID: I20040402001097 |
Provider Name | Daniel D Anderson |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1033267166 PECOS PAC ID: 8022909860 Enrollment ID: I20040823000722 |
Provider Name | F Omar B Tordilla |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1225063795 PECOS PAC ID: 2163488396 Enrollment ID: I20041208000981 |
Provider Name | Anne Q Nguyen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477630036 PECOS PAC ID: 1355379421 Enrollment ID: I20050729000758 |
Provider Name | John D Beckes |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1639118912 PECOS PAC ID: 2264466036 Enrollment ID: I20050921000444 |
Provider Name | Sarita Satpathy |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1124051552 PECOS PAC ID: 7911928239 Enrollment ID: I20051214000928 |
Provider Name | Melissa B Vourlitis |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1235236977 PECOS PAC ID: 4587686852 Enrollment ID: I20051229000756 |
Provider Name | Brij Gupta |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1174532543 PECOS PAC ID: 0446228928 Enrollment ID: I20060208000303 |
Provider Name | Teja Singh |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1205875606 PECOS PAC ID: 5193732030 Enrollment ID: I20060317000546 |
Provider Name | Aboo Nasar |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1871533380 PECOS PAC ID: 9638154131 Enrollment ID: I20060317000550 |
Provider Name | Jason S Keri |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1811915812 PECOS PAC ID: 6800806738 Enrollment ID: I20060421000398 |
Provider Name | Deborah R Ellis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427098441 PECOS PAC ID: 8022013838 Enrollment ID: I20060929000506 |
Provider Name | Anne E Brantman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689621633 PECOS PAC ID: 7113924218 Enrollment ID: I20061102000550 |
Provider Name | Richard Mallo |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1588699490 PECOS PAC ID: 9537257852 Enrollment ID: I20071119000706 |
Provider Name | Richard T Nguyen |
---|---|
Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1275724361 PECOS PAC ID: 5597846485 Enrollment ID: I20080116000856 |
Provider Name | Edward Clark Allen |
---|---|
Provider Type | Practitioner - Geriatric Psychiatry |
Provider Identifiers | NPI Number: 1881781334 PECOS PAC ID: 5890874333 Enrollment ID: I20080508000364 |
Provider Name | Loan T P Dao |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1063670966 PECOS PAC ID: 5799846986 Enrollment ID: I20081205000636 |
Provider Name | Sirpa A Tavakoli |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326016296 PECOS PAC ID: 8022089846 Enrollment ID: I20090608000177 |
Provider Name | Juan Carlos Torres Franco |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1437357852 PECOS PAC ID: 7517018856 Enrollment ID: I20090626000599 |
Provider Name | Nittly S Chahal |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1164682480 PECOS PAC ID: 8527112754 Enrollment ID: I20090821000339 |
Provider Name | Khaldoun Riad Abouelhosn |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336310093 PECOS PAC ID: 0345395687 Enrollment ID: I20090909000798 |
Provider Name | Laurie Eastwood Raher |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629000104 PECOS PAC ID: 1759575525 Enrollment ID: I20101105000352 |
Provider Name | Paul D Sargent |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1609990662 PECOS PAC ID: 6204018948 Enrollment ID: I20110316000756 |
Provider Name | David M Oliver |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1649245986 PECOS PAC ID: 5092997734 Enrollment ID: I20110316000785 |
Provider Name | Catherine Louise Clark |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013105501 PECOS PAC ID: 3274622121 Enrollment ID: I20110725000484 |
Provider Name | David G Tweedy |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1336295500 PECOS PAC ID: 4486823598 Enrollment ID: I20110805000756 |
Provider Name | Lindsey M Swan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578712303 PECOS PAC ID: 5799841144 Enrollment ID: I20110914000615 |
Provider Name | Kristyn G Pellecchia |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780981266 PECOS PAC ID: 1153594544 Enrollment ID: I20111031000537 |
Provider Name | Badalin Helvink |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1144342403 PECOS PAC ID: 4082689443 Enrollment ID: I20120404000341 |
Provider Name | Lei Guo |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1881836096 PECOS PAC ID: 0446407548 Enrollment ID: I20120824000262 |
Provider Name | Kellyann Knight |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578882478 PECOS PAC ID: 4587853155 Enrollment ID: I20130129000120 |
Provider Name | Louisa R Steiger |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1417106204 PECOS PAC ID: 3274788211 Enrollment ID: I20130225000185 |
Provider Name | Eric R Pevney |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1689920902 PECOS PAC ID: 7911131065 Enrollment ID: I20131015002048 |
Provider Name | Veronica Deatrick |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316371180 PECOS PAC ID: 0840426284 Enrollment ID: I20131113001612 |
Provider Name | Christie M.t. Remigio |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699112748 PECOS PAC ID: 8325275746 Enrollment ID: I20131210001946 |
Provider Name | Richard S Rose |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1033206552 PECOS PAC ID: 9032373089 Enrollment ID: I20140103000556 |
Provider Name | Tara P. Toohey |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1568655306 PECOS PAC ID: 1658563929 Enrollment ID: I20140903000937 |
Provider Name | Nancy N Forrest Hardy |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1942429717 PECOS PAC ID: 5698717163 Enrollment ID: I20140915001115 |
Provider Name | Bryan R Hyler |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1811218092 PECOS PAC ID: 5799904298 Enrollment ID: I20140916000858 |
Provider Name | Benjamin Joseph Hidy |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1447570031 PECOS PAC ID: 7214158260 Enrollment ID: I20141016001682 |
Provider Name | Yvette K St Martin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780006486 PECOS PAC ID: 8325359730 Enrollment ID: I20150625000952 |
Provider Name | Timothy M Veal |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326333485 PECOS PAC ID: 5193026938 Enrollment ID: I20151221000416 |
Provider Name | Rachit H Patel |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1851612303 PECOS PAC ID: 4284852229 Enrollment ID: I20160727001662 |
Provider Name | Wanda Freeman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659504264 PECOS PAC ID: 8224286893 Enrollment ID: I20160729000534 |
Provider Name | Rhodora Neu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427413947 PECOS PAC ID: 7911291513 Enrollment ID: I20160804000842 |
Provider Name | Angel Chang |
---|---|
Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1780942771 PECOS PAC ID: 1759523772 Enrollment ID: I20160810000459 |
Provider Name | Kimberly Huynh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215475710 PECOS PAC ID: 3173809811 Enrollment ID: I20170413000466 |
Provider Name | Julie Tenbrook |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164417606 PECOS PAC ID: 6709876279 Enrollment ID: I20170417002048 |
Provider Name | Raisa Yagudayeva |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1942555990 PECOS PAC ID: 9032489612 Enrollment ID: I20170714002559 |
Provider Name | Daksha Patel |
---|---|
Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1770559338 PECOS PAC ID: 3971598046 Enrollment ID: I20170725001447 |
Provider Name | La Tanya Wallace |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841453487 PECOS PAC ID: 7416253075 Enrollment ID: I20170828001878 |
Provider Name | Dillys K Owusu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396124533 PECOS PAC ID: 8123393089 Enrollment ID: I20171004000037 |
Provider Name | Clayton A Barnes Martinez |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1922453513 PECOS PAC ID: 6608142831 Enrollment ID: I20171016002708 |
Provider Name | Deomel M Soriano |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164641650 PECOS PAC ID: 1153688205 Enrollment ID: I20171128003574 |
Provider Name | Kimberly D Wright |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811400708 PECOS PAC ID: 1759640485 Enrollment ID: I20180125001636 |
Provider Name | Tiffany G Monticino |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770083198 PECOS PAC ID: 9133482136 Enrollment ID: I20180404000536 |
Provider Name | Ashlee L Bolt |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669816492 PECOS PAC ID: 5799033650 Enrollment ID: I20180808003891 |
Provider Name | Mamta D Modhwadia |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1043353667 PECOS PAC ID: 4880746791 Enrollment ID: I20180829001843 |
Provider Name | Lauren M Prasek |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932566031 PECOS PAC ID: 9830489731 Enrollment ID: I20181019002016 |
Provider Name | Christine Marie Watson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508307364 PECOS PAC ID: 0042564353 Enrollment ID: I20181126000808 |
Provider Name | Sean Patrick Leonard |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518458165 PECOS PAC ID: 7214291731 Enrollment ID: I20190102001084 |
Provider Name | Sheela L Masifi |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1124401765 PECOS PAC ID: 5991060592 Enrollment ID: I20190306000877 |
Provider Name | Ripal Chinubhai Patel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457720872 PECOS PAC ID: 1557678778 Enrollment ID: I20190312000424 |
Provider Name | Nandlal M Patel |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1891702734 PECOS PAC ID: 9537201660 Enrollment ID: I20190618003505 |
Provider Name | Scott Benjamin Roberts |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1851755904 PECOS PAC ID: 3870880255 Enrollment ID: I20190703001903 |
Provider Name | Kavita Barron |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1821418542 PECOS PAC ID: 6305175639 Enrollment ID: I20190911001195 |
Provider Name | Steven Howard Farber |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1245248574 PECOS PAC ID: 6800880873 Enrollment ID: I20191004002903 |
Provider Name | Dean Shehadeh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942688429 PECOS PAC ID: 9830421536 Enrollment ID: I20191030001041 |
Provider Name | Monique M. Urbina |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629600952 PECOS PAC ID: 8628408960 Enrollment ID: I20200428001758 |
Provider Name | Beverly A Collins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477551919 PECOS PAC ID: 5991836264 Enrollment ID: I20200511001827 |
Provider Name | Dawn E Rose |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134747595 PECOS PAC ID: 5092139287 Enrollment ID: I20200721002543 |
Provider Name | Rita Darlene Ray |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659969962 PECOS PAC ID: 0042624819 Enrollment ID: I20210208000549 |
Provider Name | Angela C Hoefke |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063012060 PECOS PAC ID: 0042626624 Enrollment ID: I20210305000420 |
Provider Name | Joshua Olson Swigart |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407347735 PECOS PAC ID: 9537410493 Enrollment ID: I20210419001811 |
Provider Name | Mohammad Y Samara |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1952413114 PECOS PAC ID: 2466341458 Enrollment ID: I20210429001136 |
Provider Name | Mabel Anti |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104215631 PECOS PAC ID: 2163748013 Enrollment ID: I20210504001275 |
Provider Name | Theresa Timony |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689818015 PECOS PAC ID: 9739455023 Enrollment ID: I20210825002639 |
Provider Name | My Van Luu Thi Nguyen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598383689 PECOS PAC ID: 8921496910 Enrollment ID: I20211025000764 |
Provider Name | Terry G Day |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023517711 PECOS PAC ID: 9436176484 Enrollment ID: I20211108001152 |
Provider Name | Nathaniel A Brown |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1295077154 PECOS PAC ID: 3072902345 Enrollment ID: I20211109000412 |
Provider Name | Katherine Barringer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255732228 PECOS PAC ID: 3072735125 Enrollment ID: I20211124001493 |
Provider Name | Justin Richard White |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538307897 PECOS PAC ID: 1456503218 Enrollment ID: I20211214000542 |
Provider Name | Sharon Anthony |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053887760 PECOS PAC ID: 8224429402 Enrollment ID: I20211222002531 |
Provider Name | Deirdreney Harris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659849420 PECOS PAC ID: 1355684671 Enrollment ID: I20220125000270 |
Provider Name | Frida C Vargas |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518630979 PECOS PAC ID: 6103219183 Enrollment ID: I20220216000298 |
Provider Name | Jenica Florina Lanier |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1013325653 PECOS PAC ID: 6002200862 Enrollment ID: I20220222001313 |
Provider Name | Shaula Carbajal Kaufman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639753262 PECOS PAC ID: 2163816802 Enrollment ID: I20220223002093 |
Provider Name | Leslie E Boling |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073082210 PECOS PAC ID: 2466796834 Enrollment ID: I20220427001695 |
Provider Name | Frederick Grubstad |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477039667 PECOS PAC ID: 1850788449 Enrollment ID: I20220429000301 |
Provider Name | Allison Breeann Leopold |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720379647 PECOS PAC ID: 3870751696 Enrollment ID: I20221013001503 |
Provider Name | Cindy Florentino |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497330294 PECOS PAC ID: 5698144061 Enrollment ID: I20221206002521 |
Provider Name | Cindy Butler |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144645094 PECOS PAC ID: 8224261045 Enrollment ID: I20221227002335 |
Provider Name | Jason Edwin Duryee |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477268936 PECOS PAC ID: 9830562727 Enrollment ID: I20230223001192 |
Provider Name | Sharon Kepple |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720460934 PECOS PAC ID: 0749653277 Enrollment ID: I20230303002323 |
Provider Name | Mariam C Ajmal |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104585090 PECOS PAC ID: 7719349646 Enrollment ID: I20230809003012 |
Provider Name | Brandon O'malley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952082646 PECOS PAC ID: 0648626481 Enrollment ID: I20231030003287 |
Provider Name | Ataa B Maty |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598446601 PECOS PAC ID: 4789048968 Enrollment ID: I20231127001009 |
Provider Name | Fei Wang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700535796 PECOS PAC ID: 0042662280 Enrollment ID: I20240123004050 |
Provider Name | John Costello |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1184202806 PECOS PAC ID: 9436510252 Enrollment ID: I20240205004409 |
Provider Name | Ann Margrette Timog |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962256453 PECOS PAC ID: 8527409275 Enrollment ID: I20240511000380 |
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