Provider Demographics
NPI:1295149045
Name:SERRANO PEREZ, OMAYRA
Entity type:Individual
Prefix:
First Name:OMAYRA
Middle Name:
Last Name:SERRANO PEREZ
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:URB. ISLAZUL NUM 3262
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-504-1055
Mailing Address - Fax:
Practice Address - Street 1:28 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2127
Practice Address - Country:US
Practice Address - Phone:787-823-5555
Practice Address - Fax:787-823-2990
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker