Provider Demographics
NPI:1245759810
Name:SERNA, STEPHANIE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SERNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3273 CLAREMONT WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3328
Mailing Address - Country:US
Mailing Address - Phone:707-254-7117
Mailing Address - Fax:707-265-6435
Practice Address - Street 1:3273 CLAREMONT WAY STE 100
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3328
Practice Address - Country:US
Practice Address - Phone:707-254-7117
Practice Address - Fax:707-265-6435
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA54829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant