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General NPI Number Information
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NPI Number | 1548459332
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Entity Type | Organization
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Legal Business Name | JOHN B. SERADJ, M.D., INC.
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 477 N EL CAMINO REAL SUITE A-308
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City | ENCINITAS
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State | CA
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Zip | 92024-1328
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Country | US
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Telephone | 760-942-6120
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Fax | 760-942-8187
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Provider Business Mailing Address
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Address Line | 477 N EL CAMINO REAL SUITE A-308
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City | ENCINITAS
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State | CA
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Zip | 92024-1328
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Country | US
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Telephone | 760-942-6120
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Fax | 760-942-8187
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN B SERADJ
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Credential | M.D.
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Telephone | 760-942-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A32900
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License Number State | CA
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