Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TH0100X | Health Service |
NPI | 1366875189 |
---|---|
Provider Name | Oscar Isaac Sermeno |
First Address | Gardena, CA 90247-1913 |
Second Address | Oxnard, CA 93036-0673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 13/06/2016 |