Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A108846 | CA |
N | 207PE0004X | Emergency Medical Services | A108846 | CA |
NPI | 1215111380 |
---|---|
Provider Name | Dr. John Peter Serra |
First Address | San Diego, CA 92103-1911 |
Second Address | San Diego, CA 92103-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 03/06/2013 |