Provider Demographics
NPI:1558953794
Name:YENTL SERRANO
Entity Type:Organization
Organization Name:YENTL SERRANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATIVE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:YENTL
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-381-3603
Mailing Address - Street 1:2007 STONE WELL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2007 STONE WELL RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3891
Practice Address - Country:US
Practice Address - Phone:562-381-3603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty