Provider Demographics
NPI:1477963767
Name:SERIJAN, REBECCA LEE (AP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEE
Last Name:SERIJAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 36TH ST W
Mailing Address - Street 2:#D
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2459
Mailing Address - Country:US
Mailing Address - Phone:941-745-1313
Mailing Address - Fax:
Practice Address - Street 1:515 36TH ST W
Practice Address - Street 2:#D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2459
Practice Address - Country:US
Practice Address - Phone:941-745-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1336171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist