Provider Demographics
NPI:1619990389
Name:SERABYN, CYNTHIA LEE (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:SERABYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11370 ANDERSON ST
Mailing Address - Street 2:SUITE 3615
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2481
Mailing Address - Fax:909-558-2608
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-946-5348
Practice Address - Fax:909-946-6598
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16577Medicare UPIN