Provider Demographics
NPI:1093401234
Name:JAIMES SERRANO, LIZETH T
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:T
Last Name:JAIMES SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9487 SW 76TH ST APT M7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3369
Mailing Address - Country:US
Mailing Address - Phone:786-389-6329
Mailing Address - Fax:
Practice Address - Street 1:9487 SW 76TH ST APT M7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3369
Practice Address - Country:US
Practice Address - Phone:786-389-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-257524106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty