Provider Demographics
NPI:1386080851
Name:SERRANO REYES, LUZ M
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:SERRANO REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:M
Other - Last Name:SERRANO REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-0841
Mailing Address - Country:US
Mailing Address - Phone:787-817-4639
Mailing Address - Fax:
Practice Address - Street 1:SECTOR ARENAS MIRAFLORES
Practice Address - Street 2:APARTADO 841
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688
Practice Address - Country:US
Practice Address - Phone:787-817-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2789OtherPHARMACIST