Healthcare Provider Details

I. General information

NPI: 1245261825
Provider Name (Legal Business Name): PATRICIA ANNE SERIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KINGS CT
UKIAH CA
95482-5023
US

IV. Provider business mailing address

PO BOX 854
CLOVERDALE CA
95425-0854
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-7700
  • Fax: 707-468-7733
Mailing address:
  • Phone: 707-894-9181
  • Fax: 707-894-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGO77853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: