Provider Demographics
NPI:1871881854
Name:SERRANO, MARIALUZ
Entity type:Individual
Prefix:
First Name:MARIALUZ
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 1:330 MOSS ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2005
Mailing Address - Country:US
Mailing Address - Phone:619-585-4221
Mailing Address - Fax:619-585-4680
Practice Address - Street 1:1940 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2833
Practice Address - Country:US
Practice Address - Phone:619-233-3381
Practice Address - Fax:619-236-8240
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator