# SENIOR DOC WISCONSIN SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932954260
- **Authorized official:** ANGELICA CONTACT (CREDENTIALING)
- **Authorized official phone:** (855) 434-7763

## Contact information

- **Practice address:** 2592 N SANTIAGO BLVD, ORANGE, CA 92867-1862
- **Practice address phone:** (855) 434-7763
- **Mailing address:** 2592 N SANTIAGO BLVD, ORANGE, CA 92867-1862
- **Mailing address phone:** (855) 434-7763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2024
- **Last updated:** 10/11/2024