Provider Demographics
NPI:1407971344
Name:SERPA, JEANINE LEA (BHS II)
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:LEA
Last Name:SERPA
Suffix:
Gender:F
Credentials:BHS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2506
Mailing Address - Country:US
Mailing Address - Phone:209-525-5080
Mailing Address - Fax:209-558-4230
Practice Address - Street 1:707 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2506
Practice Address - Country:US
Practice Address - Phone:209-525-5080
Practice Address - Fax:209-558-4230
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator