Provider Demographics
NPI:1518432772
Name:SERRANO, LUZ CARMEN
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:CARMEN
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LUZ
Other - Middle Name:CARMEN
Other - Last Name:GAONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1288 N VERDUGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-6304
Mailing Address - Country:US
Mailing Address - Phone:818-844-3376
Mailing Address - Fax:
Practice Address - Street 1:1288 N VERDUGO RD STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-6304
Practice Address - Country:US
Practice Address - Phone:818-844-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician