MEDICARE: DR. JOHN PETER SERRA M.D.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	A108846	CA
2	207P00000X	Emergency Medicine Physician	A108846	CA

General Provider Information

NPI Number	:	1215111380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PETER SERRA M.D.

Provider Business Mailing Address
First Line	:	6260 EL CAMINO REAL STE 101
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-448-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 EL CAMINO REAL STE 101
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-448-6650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	02/23/2022

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