Provider Demographics
NPI:1174612279
Name:SERNA, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SERNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S BRISTOL ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5727
Mailing Address - Country:US
Mailing Address - Phone:714-545-5503
Mailing Address - Fax:714-545-5509
Practice Address - Street 1:2620 S BRISTOL ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5727
Practice Address - Country:US
Practice Address - Phone:714-545-5503
Practice Address - Fax:714-545-5509
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46617208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466170Medicaid
CA00A466170Medicaid
CAA46617Medicare ID - Type UnspecifiedPHYSICIAN PROVIDER