Provider Demographics
NPI:1164829610
Name:SERRATO, SAMUEL (LVN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SERRATO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2474
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-2474
Mailing Address - Country:US
Mailing Address - Phone:925-727-2641
Mailing Address - Fax:
Practice Address - Street 1:3841 BRICKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8226
Practice Address - Country:US
Practice Address - Phone:707-569-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 282546164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse