Provider Demographics
NPI:1366875189
Name:SERMENO, OSCAR ISAAC
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:ISAAC
Last Name:SERMENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1913
Mailing Address - Country:US
Mailing Address - Phone:323-915-4769
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 200
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0673
Practice Address - Country:US
Practice Address - Phone:805-981-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service