Provider Demographics
NPI:1003150087
Name:SERRANO, MARIBEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:SERRANO
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1023 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4408
Mailing Address - Country:US
Mailing Address - Phone:520-223-7500
Mailing Address - Fax:
Practice Address - Street 1:1023 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4408
Practice Address - Country:US
Practice Address - Phone:415-226-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist