Healthcare Provider Details

I. General information

NPI: 1588238380
Provider Name (Legal Business Name): JUAN A SERRANO SALCEDO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W SANTA FE DR
SUN CITY AZ
85351-3020
US

IV. Provider business mailing address

10515 W SANTA FE DR
SUN CITY AZ
85351-3020
US

V. Phone/Fax

Practice location:
  • Phone: 623-832-5328
  • Fax:
Mailing address:
  • Phone: 623-832-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6659
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7637
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-005921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: