Provider Demographics
NPI:1912353459
Name:SERRANO, ROCELYN ORBON (PTA)
Entity Type:Individual
Prefix:
First Name:ROCELYN
Middle Name:ORBON
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NORTHRUP LANE
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503
Mailing Address - Country:US
Mailing Address - Phone:707-334-6910
Mailing Address - Fax:
Practice Address - Street 1:430 NORTHRUP LN
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-4190
Practice Address - Country:US
Practice Address - Phone:707-334-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant