Healthcare Provider Details

I. General information

NPI: 1245759810
Provider Name (Legal Business Name): STEPHANIE SERNA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 CLAREMONT WAY STE 100
NAPA CA
94558-3328
US

IV. Provider business mailing address

3273 CLAREMONT WAY STE 100
NAPA CA
94558-3328
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-7117
  • Fax: 707-265-6435
Mailing address:
  • Phone: 707-254-7117
  • Fax: 707-265-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA54829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: