Basic Information
| Provider Information | |||||||||
| NPI: | 1730158676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOCHA | ||||||||
| FirstName: | JILLAINE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A.- C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WADIN | ||||||||
| OtherFirstName: | JILL | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.A.- C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1260 S MAIN ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939012288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317699355 | ||||||||
| FaxNumber: | 8317544955 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317582100 | ||||||||
| FaxNumber: | 8317581565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA11365 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1912919804 | 01 | NPI - TYPE 2 | OTHER | W1514B | 01 | CA | MEDICARE PTAN - TYPE 2 | OTHER | 970013835 | 01 | CA | RAIL ROAD MEDICARE - PROVIDER PTAN | OTHER | CG5665 | 01 | CA | RAIL ROAD MEDICARE - GROUP PTAN | OTHER | W1514 | 01 | CA | MEDICARE PTAN - TYPE 2 | OTHER | 1447410519 | 01 | NPI - TYPE 2 | OTHER | W11996 | 01 | CA | MEDICARE PTAN - TYPE 2 | OTHER | 1720247455 | 01 | NPI - TYPE 2 | OTHER |