Healthcare Provider Details

I. General information

NPI: 1639080112
Provider Name (Legal Business Name): CYRIA SERRATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIVIA MOLINA

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W APACHE ST
PHOENIX AZ
85003-2729
US

IV. Provider business mailing address

330 W APACHE ST
PHOENIX AZ
85003-2729
US

V. Phone/Fax

Practice location:
  • Phone: 602-583-4253
  • Fax:
Mailing address:
  • Phone: 602-583-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number25027419
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: