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General NPI Number Information
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NPI Number | 1518436922
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Entity Type | Individual
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Provider Name | JESSICA NICOLE SERRANO I
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Gender | Female
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 1212 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95202-1552
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Country | US
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Telephone | 209-468-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 228 S ROSE ST APT 7
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City | LODI
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State | CA
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Zip | 95240-3474
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Country | US
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Telephone | 209-570-1861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 41033
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License Number State | CA
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