Individual provider Active NPI

Marisa Brianna Serrato, PA-C

  • Physician Assistant
  • Santa Maria, CA
National Provider Identifier
1215765870
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1075 E Betteravia Rd Ste 201
Santa Maria, CA 93454-7023
Phone
(805) 621-7714
NPI assigned
Jul 24, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1075 E Betteravia Rd Ste 201
Santa Maria, CA 93454-7023

Mailing address

2220 Jefferson Ave
Escondido, CA 92027-2220

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
I20241206000894 CA Practitioner - Physician Assistant 4981130531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agape Dermatology PCGroup PAC ID 0840629812, 4 clinicians

Practice addresses (Care Compare)

18800 Main St
Suite 111
Huntington Beach, CA 92648-1717
Phone (714) 951-9119

National Provider Directory

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

Organizations & group practices 1

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": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1215765870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 JEFFERSON AVE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920272220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 E BETTERAVIA RD STE 201",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547023",
            "telephone_number": "805-621-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRATO",
        "first_name": "MARISA",
        "middle_name": "BRIANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.