Provider Demographics
NPI:1932620341
Name:SERRANO, KEISHLA
Entity Type:Individual
Prefix:
First Name:KEISHLA
Middle Name:
Last Name:SERRANO
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 1:4430 NW 172ND DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4345
Mailing Address - Country:US
Mailing Address - Phone:786-273-6312
Mailing Address - Fax:
Practice Address - Street 1:18001 OLD CUTLER RD STE 649
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6442
Practice Address - Country:US
Practice Address - Phone:786-273-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician