Provider Demographics
NPI:1033579446
Name:GARCIA-SERRABLO, PURA (PSYD)
Entity Type:Individual
Prefix:
First Name:PURA
Middle Name:
Last Name:GARCIA-SERRABLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21006 42ND AVE
Mailing Address - Street 2:APT. 1E
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2771
Mailing Address - Country:US
Mailing Address - Phone:215-221-4484
Mailing Address - Fax:
Practice Address - Street 1:21006 42ND AVE
Practice Address - Street 2:APT. 1E
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2771
Practice Address - Country:US
Practice Address - Phone:215-221-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit