MEDICARE: CRISTINA V SERRANO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	3-0584	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811008329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA V SERRANO PH.D.

Provider Business Mailing Address
First Line	:	8599 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8023
Country	:	US
Telephone Number	:	409-729-7800
Fax Number	:	409-729-7825

Provider Business Practice Location Address
First Line	:	8599 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8023
Country	:	US
Telephone Number	:	409-729-7800
Fax Number	:	409-729-7825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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