Provider Demographics
NPI:1598093569
Name:SERENDIP, JAMES A (CHT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:SERENDIP
Suffix:
Gender:M
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CARISSA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8115
Mailing Address - Country:US
Mailing Address - Phone:505-670-6447
Mailing Address - Fax:
Practice Address - Street 1:1500 5TH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3480
Practice Address - Country:US
Practice Address - Phone:505-670-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist