Provider Demographics
NPI:1104408384
Name:SERRA, MARISA CRISTINA (DPT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:CRISTINA
Last Name:SERRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 RILEA WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3732
Mailing Address - Country:US
Mailing Address - Phone:415-992-0021
Mailing Address - Fax:
Practice Address - Street 1:4309 RILEA WAY APT 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3732
Practice Address - Country:US
Practice Address - Phone:415-992-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist