Provider Demographics
NPI:1558801498
Name:SERRANO, IVETTE (BA)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:IVETTE
Other - Middle Name:
Other - Last Name:CUANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:536 W VISTA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5704
Mailing Address - Country:US
Mailing Address - Phone:760-758-1650
Mailing Address - Fax:760-758-1701
Practice Address - Street 1:536 W VISTA WAY STE A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5704
Practice Address - Country:US
Practice Address - Phone:760-758-1650
Practice Address - Fax:760-758-1701
Is Sole Proprietor?:No
Enumeration Date:2017-02-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor