Provider Demographics
NPI:1891995791
Name:SERRATO, LIDIA (MT)
Entity Type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:
Last Name:SERRATO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S. HIGHLAND SPRINGS AVE.10-E
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-922-6810
Mailing Address - Fax:951-922-6726
Practice Address - Street 1:300 S. HIGHLAND SPRINGS AVE. 10-E
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220
Practice Address - Country:US
Practice Address - Phone:951-922-6810
Practice Address - Fax:951-922-6726
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist