Healthcare Provider Details

I. General information

NPI: 1669949996
Provider Name (Legal Business Name): ALEXIS MARIAH SERRANO ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CHERRY LN STE 208
MANTECA CA
95337-4311
US

IV. Provider business mailing address

302 CHERRY LN STE 208
MANTECA CA
95337-4311
US

V. Phone/Fax

Practice location:
  • Phone: 209-647-6200
  • Fax:
Mailing address:
  • Phone: 209-647-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW136353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: