Healthcare Provider Details

I. General information

NPI: 1417574724
Provider Name (Legal Business Name): JONATHAN PAUL SERNA CLINKENBEARD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HOPYARD RD STE 140&202
PLEASANTON CA
94588-8528
US

IV. Provider business mailing address

3825 HOPYARD RD STE 140&202
PLEASANTON CA
94588-8528
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5051
  • Fax:
Mailing address:
  • Phone: 925-847-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY36229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: