MEDICARE: ROGELIO SERRANO LMFT

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	106H00000X	Marriage & Family Therapist	MFC42176	CA

General Provider Information

NPI Number	:	1285895110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGELIO SERRANO LMFT

Provider Business Mailing Address
First Line	:	1940 W ORANGEWOOD AVE
Second Line	:	SUITE 101
City	:	ORANGE
State	:	CA
Zip	:	92868-2009
Country	:	US
Telephone Number	:	714-437-7693
Fax Number	:	714-744-1830

Provider Business Practice Location Address
First Line	:	1940 W ORANGEWOOD AVE
Second Line	:	SUITE 101
City	:	ORANGE
State	:	CA
Zip	:	92868-2009
Country	:	US
Telephone Number	:	714-437-7693
Fax Number	:	714-744-1830

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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