MEDICARE: DR. MAYRALIZ SERRANO DECOS AUD

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	231H00000X	Audiologist	570	PR

General Provider Information

NPI Number	:	1881601326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYRALIZ SERRANO DECOS AUD

Provider Business Mailing Address
First Line	:	LA MARINA 4 R 54 FIDELA CRUZ ST.
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7544
Country	:	US
Telephone Number	:	787-755-0707
Fax Number	:	787-755-0707

Provider Business Practice Location Address
First Line	:	1712 CALLE PARANA
Second Line	:	URB EL CEREZAL
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3148
Country	:	US
Telephone Number	:	787-755-0707
Fax Number	:	787-755-0707

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/04/2010

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