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General NPI Number Information
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NPI Number | 1356015580
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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 | 08/02/2021
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 6850 SEPULVEDA BLVD STE 209
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City | VAN NUYS
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State | CA
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Zip | 91405-4453
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Country | US
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Telephone | 818-504-4504
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Fax | 818-504-4637
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Provider Business Mailing Address
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Address Line | 9375 SAN FERNANDO RD
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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 | 818-504-4504
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Fax | 818-504-4637
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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 | 818-504-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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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 |
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