Provider Demographics
NPI:1275101107
Name:SERRALTA, LOURDES MARIA
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MARIA
Last Name:SERRALTA
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 1:813 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2173
Mailing Address - Country:US
Mailing Address - Phone:863-214-7972
Mailing Address - Fax:863-402-9147
Practice Address - Street 1:813 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2173
Practice Address - Country:US
Practice Address - Phone:863-214-7972
Practice Address - Fax:863-402-9147
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula