Provider Demographics
NPI:1730158676
Name:SOCHA, JILLAINE ANN (PA- C)
Entity type:Individual
Prefix:MS
First Name:JILLAINE
Middle Name:ANN
Last Name:SOCHA
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:WADIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA- C
Mailing Address - Street 1:1260 S MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2288
Mailing Address - Country:US
Mailing Address - Phone:831-769-9355
Mailing Address - Fax:831-754-4955
Practice Address - Street 1:230 SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3901
Practice Address - Country:US
Practice Address - Phone:831-758-2100
Practice Address - Fax:831-758-1565
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912919804OtherNPI - TYPE 2
CAW1514BOtherMEDICARE PTAN - TYPE 2
CA970013835OtherRAIL ROAD MEDICARE - PROVIDER PTAN
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN
CAW1514OtherMEDICARE PTAN - TYPE 2
1447410519OtherNPI - TYPE 2
CAW11996OtherMEDICARE PTAN - TYPE 2
1720247455OtherNPI - TYPE 2
CAWPA11365AMedicare PIN
CAWPA11365CMedicare PIN
1447410519OtherNPI - TYPE 2
CA970013835OtherRAIL ROAD MEDICARE - PROVIDER PTAN