Provider Demographics
NPI:1881901957
Name:SEROUSSI, LIDIA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:
Last Name:SEROUSSI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5064
Mailing Address - Country:US
Mailing Address - Phone:408-257-9663
Mailing Address - Fax:
Practice Address - Street 1:1123 MILKY WAY
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5064
Practice Address - Country:US
Practice Address - Phone:408-257-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6344979174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist