MEDICARE: SERENA A TU MD

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	208000000X	Pediatrics Physician	A68366	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922088459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA A TU MD

Provider Business Mailing Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	#100
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-637-7980
Fax Number	:	818-637-7985

Provider Business Practice Location Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-637-7980
Fax Number	:	818-637-7985

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/11/2010

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