Provider Demographics
NPI:1265043707
Name:PADRO SERRANO, JOANNETH MARIE
Entity Type:Individual
Prefix:
First Name:JOANNETH
Middle Name:MARIE
Last Name:PADRO 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:CONDOMINIO BOULEVARD DEL RIO II APT K324
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9273
Mailing Address - Country:US
Mailing Address - Phone:787-608-6434
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO BOULEVARD DEL RIO II
Practice Address - Street 2:APT K324
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9273
Practice Address - Country:US
Practice Address - Phone:787-608-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program