Healthcare Provider Details

I. General information

NPI: 1700110236
Provider Name (Legal Business Name): SERAPHINE T MOHLIE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

IV. Provider business mailing address

9709 ARTESIA BLVD STE 201
BELLFLOWER CA
90706-8008
US

V. Phone/Fax

Practice location:
  • Phone: 909-381-3774
  • Fax:
Mailing address:
  • Phone: 631-304-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number013104
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013104
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: