Individual provider Active NPI

Serena Le, PA

  • Physician Assistant
  • Fullerton, CA
National Provider Identifier
1184214736
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59224 Issued in CA
Practice address
2251 N Harbor Blvd
Fullerton, CA 92835-2601
Phone
(714) 449-6230
NPI assigned
Jan 18, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 59224 CA Primary

Addresses

Primary practice location

2251 N Harbor Blvd
Fullerton, CA 92835-2601

Mailing address

2251 N Harbor Blvd
Fullerton, CA 92835-2601
Phone (714) 449-6230

Other practice location 1

15855 Pomona Rincon Rd Bldg 4
Chino Hills, CA 91709-3162
Phone (909) 929-2511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210525002114 CA Practitioner - Physician Assistant 0244639292 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

15855 Pomona Rincon Rd
BLDG 4
Chino Hills, CA 91709-3162
Phone (909) 929-2511

19333 Bear Valley Rd
Apple Valley, CA 92308-5149

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

2501 E Chapman Ave
Orange, CA 92869-3204
Phone (714) 633-7175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
59224CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Apr 1, 2021 Accepting new patients

Locations

15855 Pomona Rincon Rd
Bldg 4
Chino Hills, CA 91709
Phone (714) 626-8630

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1184214736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352601",
            "telephone_number": "714-449-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352601",
            "telephone_number": "714-449-6230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15855 Pomona Rincon Rd Bldg 4",
            "address_purpose": "LOCATION",
            "city": "Chino Hills",
            "state": "CA",
            "postal_code": "917093162",
            "country_code": "US",
            "telephone_number": "909-929-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE",
        "first_name": "SERENA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-18",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.