Healthcare Provider Details

I. General information

NPI: 1629253505
Provider Name (Legal Business Name): SENIOR MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 CAMINO DEL RIO S STE 102
SAN DIEGO CA
92108-3818
US

IV. Provider business mailing address

2810 CAMINO DEL RIO S STE 102
SAN DIEGO CA
92108-3818
US

V. Phone/Fax

Practice location:
  • Phone: 858-385-1419
  • Fax: 858-461-6008
Mailing address:
  • Phone: 619-299-1419
  • Fax: 858-461-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON S KERI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-299-1419