{
"Npi": {
"NPI": "1164781803",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SERRANO",
"FirstName": "ROSA",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 962785",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL PASO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79996-2785",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-642-1454",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1909 E YANDELL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EL PASO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79903-3416",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "915-629-9639",
"PracticeLocationAddressFaxNumber": "915-261-7093",
"EnumerationDate": "05/15/2012",
"LastUpdateDate": "06/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "156FC0800X",
"TaxonomyName": "Contact Lens Technician/Technologist",
"LicenseNumber": "DR4124",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "077000",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "DR4124",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}