Provider Demographics
NPI:1831199744
Name:SERR, CHERYL A (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:SERR
Suffix:
Gender:F
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:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-225-8500
Mailing Address - Fax:530-246-4000
Practice Address - Street 1:1842 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3700
Practice Address - Country:US
Practice Address - Phone:530-225-8500
Practice Address - Fax:530-246-4000
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A689890Medicaid
CA00A689890Medicare ID - Type Unspecified
CA00A689890Medicaid