Provider Demographics
NPI:1528797958
Name:SERDA, RUSSELL CHARLES (PSYD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:CHARLES
Last Name:SERDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:CHARLES
Other - Last Name:WESLEY
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39711 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:SQUAW VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93675-8703
Mailing Address - Country:US
Mailing Address - Phone:858-527-8056
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9611
Practice Address - Country:US
Practice Address - Phone:559-992-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program