Active NPI
Senior Doc Connecticut, PC
- Family Medicine Physician
- Orange, CA
National Provider Identifier
1194575308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SENIOR DOC CONNECTICUT, PC
- Practice address
- 2592 N Santiago Blvd
Orange, CA 92867-1862 - Phone
- (855) 434-7763
- NPI assigned
- Mar 22, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Angelica Leyla Soto
- Title
- Credentialing Specialist
- Phone
- (855) 434-7763
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
2592 N Santiago Blvd
Orange, CA 92867-1862
Mailing address
2592 N Santiago Blvd
Orange, CA 92867-1862
Phone (855) 434-7763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Corona del Mar, CA
- NPI 1871185686
-
- Family Medicine Physician
- North Las Vegas, NV
- NPI 1871013631
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711065600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1711065600000",
"number": "1194575308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2592 N SANTIAGO BLVD",
"city": "ORANGE",
"state": "CA",
"postal_code": "928671862",
"telephone_number": "855-434-7763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2592 N SANTIAGO BLVD",
"city": "ORANGE",
"state": "CA",
"postal_code": "928671862",
"telephone_number": "855-434-7763"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SENIOR DOC CONNECTICUT, PC",
"organizational_subpart": "NO",
"enumeration_date": "2024-03-22",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A",
"authorized_official_last_name": "SOTO",
"authorized_official_first_name": "ANGELICA",
"authorized_official_middle_name": "LEYLA",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "855-434-7763"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.