Provider Demographics
NPI:1275935926
Name:SERRANO MOLINA, LOURDES (MS, CCCSLP)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:SERRANO MOLINA
Suffix:
Gender:F
Credentials:MS, CCCSLP
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 23
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-0023
Mailing Address - Country:US
Mailing Address - Phone:787-632-6296
Mailing Address - Fax:
Practice Address - Street 1:133 CALLE DR GONZALEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2633
Practice Address - Country:US
Practice Address - Phone:787-872-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1197216OtherDRIVERS LICENSE