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General NPI Number Information
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NPI Number | 1588430367
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Entity Type | Organization
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Legal Business Name | SENIOR DOC WA PC
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 912 STATE AVE
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City | MARYSVILLE
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State | WA
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Zip | 98270-4239
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Country | US
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Telephone | 855-434-7763
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Fax | 949-281-5550
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Provider Business Mailing Address
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Address Line | 5 HUTTON CENTRE DR STE 950
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City | SANTA ANA
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State | CA
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Zip | 92707-8744
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Country | US
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Telephone | 855-434-7763
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Fax | 949-281-5550
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ANGELICA SOTO
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Credential |
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Telephone | 714-702-5145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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