Provider Demographics
NPI:1669294534
Name:SERRANO, OLIVIA OLAZARAN (DDS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:OLAZARAN
Last Name:SERRANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 EASTBORNE AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6062
Mailing Address - Country:US
Mailing Address - Phone:951-377-2132
Mailing Address - Fax:
Practice Address - Street 1:9810 SIERRA AVE STE D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6779
Practice Address - Country:US
Practice Address - Phone:909-417-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist