Provider Demographics
NPI:1265757801
Name:SERRANO, MYRNALIS
Entity type:Individual
Prefix:
First Name:MYRNALIS
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 1:152 CALLE NOBLEZA
Mailing Address - Street 2:PASEOS REALES
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 CALLE NOBLEZA
Practice Address - Street 2:PASEOS REALES
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-5511
Practice Address - Country:US
Practice Address - Phone:787-604-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist