MEDICARE: SANTA ROSA FAMILY MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1023039765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA ROSA FAMILY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	4055 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2536
Country	:	US
Telephone Number	:	323-261-4641
Fax Number	:	323-261-4757

Provider Business Practice Location Address
First Line	:	4055 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2536
Country	:	US
Telephone Number	:	323-261-4641
Fax Number	:	323-261-4757

Authorized Official
Title or Position	:	MEDICAL
Name	:	DR. RAFAEL ANTONIO SERNA
Credential	:	M.D
Telephone Number	:	323-804-6569

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/11/2025

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