Healthcare Provider Details

I. General information

NPI: 1750314704
Provider Name (Legal Business Name): ARMEN SEREBRAKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 TARA HILLS DR
PINOLE CA
94564-2519
US

IV. Provider business mailing address

1599 TARA HILLS DR
PINOLE CA
94564-2519
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-7629
  • Fax: 510-724-1959
Mailing address:
  • Phone: 510-724-7629
  • Fax: 510-724-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA38572
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA38572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: