Healthcare Provider Details

I. General information

NPI: 1043232630
Provider Name (Legal Business Name): DOLORES SELENA SERRECCHIA BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 NW 8TH AVE
MIAMI FL
33136-1425
US

IV. Provider business mailing address

1261 NW 193RD AVE
PEMBROKE PINES FL
33029-3221
US

V. Phone/Fax

Practice location:
  • Phone: 305-547-2500
  • Fax: 305-547-2673
Mailing address:
  • Phone: 305-547-2500
  • Fax: 305-547-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1955832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: