1427179290 NPI number — MRS. SANDRA SERRANO RAS

Table of content: MRS. SANDRA SERRANO RAS (NPI 1427179290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427179290 NPI number — MRS. SANDRA SERRANO RAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RAS
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:
1427179290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
178 W BEAMER ST
Provider Second Line Business Mailing Address:
14 N. COTTONWOOD STREET
Provider Business Mailing Address City Name:
WOODLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95695-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-666-8658
Provider Business Mailing Address Fax Number:
530-666-8663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
178 W BEAMER ST
Provider Second Line Business Practice Location Address:
14 N. COTTONWOOD STREET
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95695-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-666-8658
Provider Business Practice Location Address Fax Number:
530-666-8663
Provider Enumeration Date:
04/02/2007

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: 101Y00000X , with the licence number:  S0502181644 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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