Provider Demographics
NPI:1568771871
Name:SERPAS, ROSA ELISA (MS)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:ELISA
Last Name:SERPAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1523
Mailing Address - Country:US
Mailing Address - Phone:415-420-5953
Mailing Address - Fax:
Practice Address - Street 1:450 MANOR PLZ
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1839
Practice Address - Country:US
Practice Address - Phone:650-355-8787
Practice Address - Fax:650-355-8780
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist