Healthcare Provider Details

I. General information

NPI: 1275886830
Provider Name (Legal Business Name): SENIOR CARE MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 CAMINO DE LOS MARES SUITE 122
SAN CLEMENTE CA
92673-2809
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 108
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-7262
  • Fax: 949-588-7260
Mailing address:
  • Phone: 949-588-7262
  • Fax: 949-588-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY JAMLANG
Title or Position: OFFICE MANAGER
Credential:
Phone: 949-588-2166