Provider Demographics
NPI:1003622341
Name:LOPEZ SERRANO, KEILAN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KEILAN
Middle Name:
Last Name:LOPEZ SERRANO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 NW 95TH ST STE 337
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2361
Mailing Address - Country:US
Mailing Address - Phone:954-793-0775
Mailing Address - Fax:786-641-5968
Practice Address - Street 1:8040 NW 95TH ST STE 337
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2361
Practice Address - Country:US
Practice Address - Phone:954-793-0775
Practice Address - Fax:786-641-5968
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9421563163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult