Healthcare Provider Details

I. General information

NPI: 1093689119
Provider Name (Legal Business Name): LIZETTE CERNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80495 US HIGHWAY 111
INDIO CA
92201-6534
US

IV. Provider business mailing address

80495 US HIGHWAY 111
INDIO CA
92201-6534
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-2887
  • Fax: 760-347-0776
Mailing address:
  • Phone: 760-347-2887
  • Fax: 760-347-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95037127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: