Basic Information
| Provider Information | |||||||||
| NPI: | 1316256258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERRANO | ||||||||
| FirstName: | LUPITA | ||||||||
| MiddleName: | NABIL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 CLAYTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094307643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 847 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093837441 | ||||||||
| FaxNumber: | 2093830318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 03/22/2018 | ||||||||
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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 | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW78534 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.