1245530229 NPI number — MISS IDARMA C. SERRANO GARCIA M. PSY.

Table of content: MISS IDARMA C. SERRANO GARCIA M. PSY. (NPI 1245530229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245530229 NPI number — MISS IDARMA C. SERRANO GARCIA M. PSY.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO GARCIA
Provider First Name:
IDARMA
Provider Middle Name:
C.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M. PSY.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245530229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND JARDINES DEL PARQUE
Provider Second Line Business Mailing Address:
69 BLVD. MEDIA LUNA APT. 3001
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987-4925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-477-4192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 AVE. PONCE DE LEON
Provider Second Line Business Practice Location Address:
SUITE 304-B
Provider Business Practice Location Address City Name:
SAN JUAN (HATO REY)
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-750-1472
Provider Business Practice Location Address Fax Number:
787-750-1472
Provider Enumeration Date:
10/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3820 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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