Provider Demographics
NPI:1245617935
Name:SERRANO, ANGELYS
Entity Type:Individual
Prefix:
First Name:ANGELYS
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANGELYS
Other - Middle Name:M
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LND
Mailing Address - Street 1:AVE PONCE DE LEON # 715
Mailing Address - Street 2:NUTRITION DEPT.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3907
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:787-771-7951
Practice Address - Street 1:AVE PONCE DE LEON # 715
Practice Address - Street 2:NUTRITION DEPT.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3907
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7951
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1925132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1925OtherDIETICIAN'S LICENSE