Provider Demographics
NPI:1518911395
Name:MRAZ, SERENA (MD)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:MRAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:MRAZ-GERNHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2290 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2929
Mailing Address - Country:US
Mailing Address - Phone:707-643-5785
Mailing Address - Fax:707-643-8810
Practice Address - Street 1:2290 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2929
Practice Address - Country:US
Practice Address - Phone:707-643-5785
Practice Address - Fax:707-643-8810
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81439207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0023150Medicaid
CA00G814391Medicare ID - Type Unspecified
CAGR0023150Medicaid