Provider Demographics
NPI:1457579914
Name:SERNA, GISELA PORRAS (MD)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:PORRAS
Last Name:SERNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9830 NE CASCADES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-6834
Mailing Address - Country:US
Mailing Address - Phone:503-239-8101
Mailing Address - Fax:503-234-0924
Practice Address - Street 1:2801 N GANTENBEIN AVE STE 2225
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-4505
Practice Address - Fax:503-413-4719
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD129022080P0006X
ORMD1688452080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD12902OtherLICENSE
ORMD168845OtherMEDICAL LICENSE