Provider Demographics
NPI:1083468987
Name:SERRANO, ISABELLA MARIA
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MARIA
Last Name:SERRANO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:FERNANDO
Other - Middle Name:ALFREDO
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2755 NE JOHN OLSEN AVE APT F76
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7177
Mailing Address - Country:US
Mailing Address - Phone:925-413-3725
Mailing Address - Fax:
Practice Address - Street 1:2167 NW 185TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7074
Practice Address - Country:US
Practice Address - Phone:503-386-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist