Provider Demographics
NPI:1235019019
Name:SERNAS LOPEZ, KEYSI SARAI (ATC)
Entity type:Individual
Prefix:
First Name:KEYSI
Middle Name:SARAI
Last Name:SERNAS LOPEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 S BEDFORD ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1329
Mailing Address - Country:US
Mailing Address - Phone:310-733-0551
Mailing Address - Fax:
Practice Address - Street 1:1946 S BEDFORD ST APT 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1329
Practice Address - Country:US
Practice Address - Phone:310-733-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer