Provider Demographics
NPI:1487668323
Name:OLIVIA SERNA
Entity Type:Organization
Organization Name:OLIVIA SERNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-541-4409
Mailing Address - Street 1:2500 EL PASEO RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:575-541-4409
Mailing Address - Fax:575-541-4452
Practice Address - Street 1:2500 EL PASEO RD.
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-541-4409
Practice Address - Fax:575-541-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11639332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61677035Medicaid
NMNM00TB93OtherBLUE CROSS BLUE SHIELD OF NEW MEXICO
NMNM00TB93OtherBLUE CROSS BLUE SHIELD OF NEW MEXICO