Provider Demographics
NPI:1942853114
Name:SERAPIA, MAYRA MARITZA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:MARITZA
Last Name:SERAPIA
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 1:14805 SAGUARO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-5593
Mailing Address - Country:US
Mailing Address - Phone:909-269-2554
Mailing Address - Fax:
Practice Address - Street 1:14805 SAGUARO ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-5593
Practice Address - Country:US
Practice Address - Phone:909-269-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)