Healthcare Provider Details

I. General information

NPI: 1730158676
Provider Name (Legal Business Name): JILLAINE ANN SOCHA P.A.- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN WADIN P.A.- C

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SAN JOSE ST
SALINAS CA
93901-3901
US

IV. Provider business mailing address

1260 S MAIN ST SUITE 202
SALINAS CA
93901-2288
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-2100
  • Fax: 831-758-1565
Mailing address:
  • Phone: 831-769-9355
  • Fax: 831-754-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: