Provider Demographics
NPI:1750648127
Name:SERRANO, MARIA MAGALY
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MAGALY
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOSPITAL INDUSTRIAL 365028
Mailing Address - Street 2:CENTRO MEDICO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5028
Mailing Address - Country:US
Mailing Address - Phone:787-398-9428
Mailing Address - Fax:787-282-7426
Practice Address - Street 1:HOSPITAL INDUSTRIAL 365028
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5028
Practice Address - Country:US
Practice Address - Phone:787-398-9428
Practice Address - Fax:787-282-7426
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0935183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician