Basic Information
| Provider Information | |||||||||
| NPI: | 1659802098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SERRANO | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | C | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | SERRANO | ||||||||
| OtherFirstName: | TATIANA | ||||||||
| OtherMiddleName: | CAROLINA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1200 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134817464 | ||||||||
| FaxNumber: | 2134817147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134817464 | ||||||||
| FaxNumber: | 2134817147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 03/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF92595 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.