Healthcare Provider Details

I. General information

NPI: 1861069502
Provider Name (Legal Business Name): ERIC SERNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30135 TECHNOLOGY DR STE 100150
MURRIETA CA
92563-2653
US

IV. Provider business mailing address

1414 E FLORENCE AVE
LOS ANGELES CA
90001-1937
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-2751
Mailing address:
  • Phone: 323-588-1383
  • Fax: 323-588-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number60536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: