Provider Demographics
NPI:1174689053
Name:SERRANO, MAUREEN ELISE (RD)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ELISE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:RD
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 1286
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85358-1286
Mailing Address - Country:US
Mailing Address - Phone:623-388-9281
Mailing Address - Fax:623-388-9281
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:928-684-5421
Practice Address - Fax:623-388-9281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71409Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER