Provider Demographics
NPI:1912891383
Name:SERRANO, MARK JOSEPH (RN)
Entity type:Individual
Prefix:MR
First Name:MARK JOSEPH
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 VIA PESCARA
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CYN
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1412
Mailing Address - Country:US
Mailing Address - Phone:707-205-7410
Mailing Address - Fax:
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95349655163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health