Provider Demographics
NPI:1093821951
Name:SERRANO GARCIA, LILLIAN TERESA (MD PSYCHIATRIST)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:TERESA
Last Name:SERRANO GARCIA
Suffix:
Gender:F
Credentials:MD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:K9 TOLIMA STREET PARK GARDENS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2146
Mailing Address - Country:US
Mailing Address - Phone:787-761-5877
Mailing Address - Fax:
Practice Address - Street 1:FONT MARTELLO STREET #53
Practice Address - Street 2:HUMACAO MEDICAL PLAZA SUITE 101
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-285-4320
Practice Address - Fax:787-285-4320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11429261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11112-0OtherBNDD
PRBS4197011OtherDEA
PRH82099Medicare UPIN
PR89083SEMedicare ID - Type UnspecifiedMEDICARE & TRIPLE S