Provider Demographics
NPI:1255378840
Name:FRIEDMAN, SERENA MAYE (MD)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:MAYE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2876 SYCAMORE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1530
Mailing Address - Country:US
Mailing Address - Phone:805-526-9242
Mailing Address - Fax:805-526-3768
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1530
Practice Address - Country:US
Practice Address - Phone:805-526-9242
Practice Address - Fax:805-526-3768
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG32511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029710Medicaid
CAA45177Medicare UPIN
CAW10532Medicare ID - Type Unspecified