Provider Demographics
NPI:1972683944
Name:SEREBRIN, JONATHAN HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HARRY
Last Name:SEREBRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2954
Mailing Address - Country:US
Mailing Address - Phone:310-492-5803
Mailing Address - Fax:
Practice Address - Street 1:1224 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-3333
Practice Address - Country:US
Practice Address - Phone:909-802-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 36895146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD 33308Medicare UPIN