Healthcare Provider Details

I. General information

NPI: 1033072061
Provider Name (Legal Business Name): KATIRIA JAMILEYSHKA SERRANO-VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2587 HOPE MILLS RD
FAYETTEVILLE NC
28306-8684
US

IV. Provider business mailing address

2925 SINGLETREE LN
FAYETTEVILLE NC
28306-8386
US

V. Phone/Fax

Practice location:
  • Phone: 919-375-0475
  • Fax:
Mailing address:
  • Phone: 910-689-6241
  • Fax: 910-689-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: