Provider Demographics
NPI:1548459332
Name:JOHN B. SERADJ, M.D., INC.
Entity type:Organization
Organization Name:JOHN B. SERADJ, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SERADJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-942-6120
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE A-308
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-942-6120
Mailing Address - Fax:760-942-8187
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE A-308
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-942-6120
Practice Address - Fax:760-942-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty