Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY20340 | CA |
N | 103TC0700X | Clinical Psychologist | PSY20340 | CA |
N | 102L00000X | Psychologist | PSY20340 | CA |
N | 103T00000X | Psychologist | PSY20340 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY20340 | CA |
NPI | 1184727158 |
---|---|
Provider Name | John Gregory Serpa |
First Address | Los Angeles, CA 90073 |
Second Address | Los Angeles, CA 90073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |