MEDICARE: RAY MATIAS SERAFINO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	AL3262H	AZ

General Provider Information

NPI Number	:	1063219236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAY MATIAS SERAFINO RN

Provider Business Mailing Address
First Line	:	1974 E CLEAR LAKE DR
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6742
Country	:	US
Telephone Number	:	928-201-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1974 E CLEAR LAKE DR
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6742
Country	:	US
Telephone Number	:	928-201-5033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2025

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