Provider Demographics
NPI:1962458067
Name:SOCHA, SUSAN G (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:SOCHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10070
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0070
Mailing Address - Country:US
Mailing Address - Phone:562-809-3543
Mailing Address - Fax:
Practice Address - Street 1:1111 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-774-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59740Medicaid
E57365Medicare UPIN
CAW20A5974EMedicare PIN