Provider Demographics
NPI:1083874432
Name:SERNA, CECILIA A
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:A
Last Name:SERNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 N PERSHING AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6965
Mailing Address - Country:US
Mailing Address - Phone:209-476-8533
Mailing Address - Fax:
Practice Address - Street 1:4330 N PERSHING AVE STE B3
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6965
Practice Address - Country:US
Practice Address - Phone:209-476-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5125098OtherDRIVER LICENSE