Provider Demographics
NPI:1093175911
Name:SERRANO, VANESSA (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 SW 20TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1938
Mailing Address - Country:US
Mailing Address - Phone:786-376-6104
Mailing Address - Fax:
Practice Address - Street 1:5555 PONCE DE LEON BLVD OFC 485F
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2513
Practice Address - Country:US
Practice Address - Phone:305-689-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7646133V00000X
FL86034097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered