MEDICARE: KAREN MARIE SERRANO

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	171100000X	Acupuncturist	812	NM

General Provider Information

NPI Number	:	1912011354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MARIE SERRANO

Provider Business Mailing Address
First Line	:	1028 DON DIEGO AVE
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1627
Country	:	US
Telephone Number	:	505-670-9966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 S. ST FRANCIS #E
Second Line	:	ANCIENT TIDE WELLNESS
City	:	SANTA FE
State	:	NM
Zip	:	87505
Country	:	US
Telephone Number	:	505-670-9966
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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