Healthcare Provider Details

I. General information

NPI: 1699662007
Provider Name (Legal Business Name): GINA SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 30TH ST
OAKLAND CA
94609-3302
US

IV. Provider business mailing address

3115 13TH AVE
OAKLAND CA
94610-4008
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-9200
  • Fax:
Mailing address:
  • Phone: 347-423-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: