Healthcare Provider Details

I. General information

NPI: 1285827550
Provider Name (Legal Business Name): SERINA ROSENKJAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 VAN NUYS BLVD
VAN NUYS CA
91401-3624
US

IV. Provider business mailing address

5935 VAN NUYS BLVD
VAN NUYS CA
91401-3624
US

V. Phone/Fax

Practice location:
  • Phone: 818-285-1900
  • Fax:
Mailing address:
  • Phone: 818-285-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY18963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 18963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: