Provider Demographics
NPI:1790420941
Name:SERRANO, LIDIA ISABEL
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:ISABEL
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 1:1140 PETREE ST APT 168
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2424
Mailing Address - Country:US
Mailing Address - Phone:818-423-1058
Mailing Address - Fax:
Practice Address - Street 1:1140 PETREE ST APT 168
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2424
Practice Address - Country:US
Practice Address - Phone:818-423-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician