Provider Demographics
NPI:1346369543
Name:SERRET, MARISELA
Entity type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:SERRET
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 1:11765 SW 18TH ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8717
Mailing Address - Country:US
Mailing Address - Phone:305-228-7059
Mailing Address - Fax:
Practice Address - Street 1:8900 SW 24TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-220-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist