Healthcare Provider Details

I. General information

NPI: 1588422018
Provider Name (Legal Business Name): ISAIAH MISAEL SERRANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 BROOKHURST ST STE 201
GARDEN GROVE CA
92840-2865
US

IV. Provider business mailing address

713 W COMMONWEALTH AVE STE C
FULLERTON CA
92832-1612
US

V. Phone/Fax

Practice location:
  • Phone: 657-261-7140
  • Fax: 714-922-1032
Mailing address:
  • Phone: 714-879-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: