Provider Demographics
NPI:1801456991
Name:SERRANO CORDERO, MARIA DEL ROCIO
Entity type:Individual
Prefix:
First Name:MARIA DEL ROCIO
Middle Name:
Last Name:SERRANO CORDERO
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 1:181 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1022
Mailing Address - Country:US
Mailing Address - Phone:415-350-5912
Mailing Address - Fax:
Practice Address - Street 1:1820 SONOMA AVE STE 42
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6617
Practice Address - Country:US
Practice Address - Phone:707-528-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist