Provider Demographics
NPI:1023258290
Name:TONSTAD, SERENA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:TONSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24785 STEWART ST
Mailing Address - Street 2:EVANS HALL, ROOM 111
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4741
Mailing Address - Fax:909-558-0471
Practice Address - Street 1:24785 STEWART ST
Practice Address - Street 2:EVANS HALL, ROOM 111
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4741
Practice Address - Fax:909-558-0471
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG636002083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine