Provider Demographics
NPI:1083725279
Name:DONALD N SERAFANO MD INC
Entity Type:Organization
Organization Name:DONALD N SERAFANO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:SERAFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-598-3160
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:STE204
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-598-3160
Mailing Address - Fax:562-598-7383
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:STE 204
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5403
Practice Address - Country:US
Practice Address - Phone:562-598-3160
Practice Address - Fax:562-598-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37441207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0514780001Medicare NSC
CAW15010Medicare PIN
CADC1507Medicare PIN
A36628Medicare UPIN