Provider Demographics
NPI:1831889336
Name:LOERA SERNA, JESSICA GUADALUPE (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GUADALUPE
Last Name:LOERA SERNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31682 VIA VENTANA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3374
Mailing Address - Country:US
Mailing Address - Phone:760-641-4396
Mailing Address - Fax:
Practice Address - Street 1:4050 AIRPORT CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1216
Practice Address - Country:US
Practice Address - Phone:760-641-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC3664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor