Provider Demographics
NPI:1922356484
Name:ADVENTIST HEALTH PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PHYSICIANS NETWORK
Other - Org Name:ST. HELENA MEDICAL SPECIALTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-406-0087
Mailing Address - Street 1:PO BOX 888974
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:STE 2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-224-7400
Practice Address - Fax:707-224-7413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10588207Y00000X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1196036Medicare PIN
CAI54258Medicare UPIN