Healthcare Provider Details

I. General information

NPI: 1225575285
Provider Name (Legal Business Name): MILAGROS M SERRANO ORTIZ M.S.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 02/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S DE LACEY AVE SUITE 110
PASADENA CA
91105-2048
US

IV. Provider business mailing address

210 S DE LACEY AVE SUITE 110
PASADENA CA
91105-2048
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-395-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: