Active NPI
Senior Doc Wa PC
- Family Medicine Physician
- Marysville, WA
National Provider Identifier
1588430367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SENIOR DOC WA PC
- Practice address
- 912 State Ave
Marysville, WA 98270-4239 - Phone
- (855) 434-7763
- Fax
- (949) 281-5550
- NPI assigned
- Dec 1, 2023
- Last updated
- Sep 11, 2025
- 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 Soto
- Title
- Credentialing Specialist
- Phone
- (714) 702-5145
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
912 State Ave
Marysville, WA 98270-4239
Mailing address
5 Hutton Centre Dr Ste 950
Santa Ana, CA 92707-8744
Phone (855) 434-7763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Nurse Practitioner
- Tacoma, WA
- NPI 1689148090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701388800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1588430367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 HUTTON CENTRE DR STE 950",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927078744",
"telephone_number": "855-434-7763",
"fax_number": "949-281-5550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 STATE AVE",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982704239",
"telephone_number": "855-434-7763",
"fax_number": "949-281-5550"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SENIOR DOC WA PC",
"organizational_subpart": "NO",
"enumeration_date": "2023-12-01",
"last_updated": "2025-09-11",
"certification_date": "2025-09-11",
"status": "A",
"authorized_official_last_name": "SOTO",
"authorized_official_first_name": "ANGELICA",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "714-702-5145"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marysville, WA
- Sea-Mar Community Health Center
- Sea-Mar Community Health Center
- Select Physical Therapy Orthopedic Services Inc
- Select Physical Therapy Orthopedic Services Inc
- Selevive Continuum of Care Afh
- Maria Magdalena Mauricio Serafin
- Serenity Minds Health PLLC
- Rebecca Lynn Sewares, LMP
- Tiffany Lee Shanks, LMP
- Sydney Shaphren, MCOUN, NCC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.