Basic Information
Provider Information | |||||||||
NPI: | 1134875800 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SINDORO | ||||||||
FirstName: | SERAFIM | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10985 CLEMENTINE WAY | ||||||||
Address2: |   | ||||||||
City: | LOMA LINDA | ||||||||
State: | CA | ||||||||
PostalCode: | 923546104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6262153324 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11262 CAMPUS ST | ||||||||
Address2: |   | ||||||||
City: | LOMA LINDA | ||||||||
State: | CA | ||||||||
PostalCode: | 923501727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9095584923 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2022 | ||||||||
LastUpdateDate: | 02/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/22/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95037899 | CA | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.