Healthcare Provider Details

I. General information

NPI: 1891995791
Provider Name (Legal Business Name): LIDIA SERRATO MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S. HIGHLAND SPRINGS AVE. 10-E
BANNING CA
92220
US

IV. Provider business mailing address

300 S. HIGHLAND SPRINGS AVE.10-E
BANNING CA
92220
US

V. Phone/Fax

Practice location:
  • Phone: 951-922-6810
  • Fax: 951-922-6726
Mailing address:
  • Phone: 951-922-6810
  • Fax: 951-922-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: