Provider Demographics
NPI:1033982558
Name:SANTOS SERRANO, ILIA DOLORES (MSWC)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:DOLORES
Last Name:SANTOS SERRANO
Suffix:
Gender:F
Credentials:MSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA DEL MONTE 278
Mailing Address - Street 2:CALLE MONTE BELLO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-225-2022
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA DEL MONTE 278
Practice Address - Street 2:CALLE MONTE BELLO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-225-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR161231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical