Provider Demographics
NPI:1295616308
Name:SERRANO, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name: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 1:8450 N 59TH AVE APT 126
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5580
Mailing Address - Country:US
Mailing Address - Phone:602-999-1551
Mailing Address - Fax:
Practice Address - Street 1:8450 N 59TH AVE APT 126
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5580
Practice Address - Country:US
Practice Address - Phone:602-999-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZB07010143347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker