Healthcare Provider Details

I. General information

NPI: 1689617938
Provider Name (Legal Business Name): TRACIE A SERRATO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACIE A FEAR PA

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W ALAMEDA AVE STE 208
BURBANK CA
91505-4338
US

IV. Provider business mailing address

811 W 7TH ST STE 1200
LOS ANGELES CA
90017-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-430-7324
  • Fax:
Mailing address:
  • Phone: 310-430-7325
  • Fax: 310-878-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: