Healthcare Provider Details

I. General information

NPI: 1821925165
Provider Name (Legal Business Name): GALLERIA BLUEPRINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 NORTHRIDGE RD
ATLANTA GA
30350-6129
US

IV. Provider business mailing address

3905 NORWOOD DR
MCKINNEY TX
75071-7270
US

V. Phone/Fax

Practice location:
  • Phone: 305-401-3541
  • Fax:
Mailing address:
  • Phone: 305-401-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: DECARLO SERRANO
Title or Position: OWNER
Credential:
Phone: 305-401-3541