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General NPI Number Information
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NPI Number | 1275545725
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Entity Type | Organization
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Legal Business Name | SERRA COMMUNITY MEDICAL CLINIC INC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9375 SAN FERNANDO RD 6TH FLOOR
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City | SUN VALLEY
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State | CA
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Zip | 91352-1418
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Country | US
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Telephone | 818-768-3000
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Fax | 818-504-4690
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Provider Business Mailing Address
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Address Line | 9375 SAN FERNANDO RD FL 6
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City | SUN VALLEY
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State | CA
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Zip | 91352-1418
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Country | US
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Telephone | 818-768-3000
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Fax | 818-504-4690
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. LILY PEREZ
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Credential |
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Telephone | 818-768-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | CA
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Taxonomy #11
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #12
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State | CA
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