Healthcare Provider Details

I. General information

NPI: 1588787790
Provider Name (Legal Business Name): SERRA COMMUNITY MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 SAN FERNANDO RD
SUN VALLEY CA
91352-1418
US

IV. Provider business mailing address

9375 SAN FERNANDO RD
SUN VALLEY CA
91352-1418
US

V. Phone/Fax

Practice location:
  • Phone: 818-768-3000
  • Fax: 818-504-4690
Mailing address:
  • Phone: 818-768-3000
  • Fax: 818-504-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number930000976
License Number StateCA

VIII. Authorized Official

Name: MR. SADAYAPPA K DURAIRAJ
Title or Position: C.E.O.
Credential: M.D.
Phone: 818-768-3000