Provider Demographics
NPI:1780356550
Name:SERAFIN, MARIA MAGDALENA MAURICIO
Entity type:Individual
Prefix:
First Name:MARIA MAGDALENA
Middle Name:MAURICIO
Last Name:SERAFIN
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 1:4310 92ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2539
Mailing Address - Country:US
Mailing Address - Phone:360-925-6390
Mailing Address - Fax:360-925-6390
Practice Address - Street 1:4310 92ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2539
Practice Address - Country:US
Practice Address - Phone:360-925-6390
Practice Address - Fax:360-925-6390
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755164311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home