Provider Demographics
NPI:1669759403
Name:SERRA, NANCY MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARIA
Last Name:SERRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CALLE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3228
Mailing Address - Country:US
Mailing Address - Phone:787-871-3091
Mailing Address - Fax:787-871-3091
Practice Address - Street 1:51 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3228
Practice Address - Country:US
Practice Address - Phone:787-871-3091
Practice Address - Fax:787-871-3091
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist