Provider Demographics
NPI:1124150966
Name:SERRANO SERRANO, SONIA I (RD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:I
Last Name:SERRANO SERRANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CALLE CORNELL
Mailing Address - Street 2:APT 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4102
Mailing Address - Country:US
Mailing Address - Phone:787-242-0595
Mailing Address - Fax:
Practice Address - Street 1:207 CALLE CORNELL
Practice Address - Street 2:APT 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4102
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-756-8529
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR890133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR890OtherJUNTA DE PROFESIONALES DE LA SALUD DE PR