Healthcare Provider Details

I. General information

NPI: 1528183209
Provider Name (Legal Business Name): EDWARD ARTURO SERNA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE STE 102
PARAMOUNT CA
90723-5051
US

IV. Provider business mailing address

16415 COLORADO AVE STE 102
PARAMOUNT CA
90723-5051
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-1946
  • Fax:
Mailing address:
  • Phone: 562-531-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: