Healthcare Provider Details

I. General information

NPI: 1710168091
Provider Name (Legal Business Name): JOSE SERNA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

IV. Provider business mailing address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-0831
  • Fax:
Mailing address:
  • Phone: 562-437-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 10134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: