Healthcare Provider Details

I. General information

NPI: 1104712090
Provider Name (Legal Business Name): CHRISTOPHER DAVID SERNA CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

IV. Provider business mailing address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

V. Phone/Fax

Practice location:
  • Phone: 619-478-5696
  • Fax:
Mailing address:
  • Phone: 619-478-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HMNCVA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: