Provider Demographics
NPI:1063219236
Name:SERAFINO, RAY MATIAS (RN)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:MATIAS
Last Name:SERAFINO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 E CLEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6742
Mailing Address - Country:US
Mailing Address - Phone:928-201-5033
Mailing Address - Fax:
Practice Address - Street 1:1974 E CLEAR LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6742
Practice Address - Country:US
Practice Address - Phone:928-201-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL3262H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home