Provider Demographics
NPI:1386843282
Name:SERBAN, THEODOR NICOLAE (RPT)
Entity Type:Individual
Prefix:MR
First Name:THEODOR
Middle Name:NICOLAE
Last Name:SERBAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2329
Mailing Address - Country:US
Mailing Address - Phone:626-679-6432
Mailing Address - Fax:323-262-1563
Practice Address - Street 1:208 N PINE ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2329
Practice Address - Country:US
Practice Address - Phone:626-679-6432
Practice Address - Fax:323-262-1563
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist