Provider Demographics
NPI:1306687280
Name:SERRANO-LUGO, IZA M
Entity type:Individual
Prefix:
First Name:IZA
Middle Name:M
Last Name:SERRANO-LUGO
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 1:3000 CALLE CORAL APT 432
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3057
Mailing Address - Country:US
Mailing Address - Phone:787-314-9523
Mailing Address - Fax:
Practice Address - Street 1:AVE BOULEVARD EE10 LOCAL #3
Practice Address - Street 2:6TA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0000
Practice Address - Country:US
Practice Address - Phone:787-314-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006914103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist