Provider Demographics
NPI:1518324698
Name:SERNA, VICTORIA (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SERNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 COUNTY ROAD 335
Mailing Address - Street 2:TRLR 26
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9663
Mailing Address - Country:US
Mailing Address - Phone:970-989-8702
Mailing Address - Fax:970-984-3198
Practice Address - Street 1:820 CASTLE VALLEY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9453
Practice Address - Country:US
Practice Address - Phone:970-989-8702
Practice Address - Fax:970-984-3198
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.008324171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMT.0008324OtherMASSAGE THERAPIST LICENSE