Provider Demographics
NPI:1871122671
Name:SERRANO, JOANNA BIANCA CODILLA (OTR/L)
Entity type:Individual
Prefix:
First Name:JOANNA BIANCA
Middle Name:CODILLA
Last Name:SERRANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOANNA BIANCA
Other - Middle Name:CABALLERO
Other - Last Name:CODILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:375 LAGUNA HONDA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1499
Mailing Address - Country:US
Mailing Address - Phone:415-682-5726
Mailing Address - Fax:
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-682-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist