MEDICARE: IDELSIS SERRANO

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	106S00000X	Behavior Technician	RBT25-488642	FL

General Provider Information

NPI Number	:	1609722826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDELSIS SERRANO

Provider Business Mailing Address
First Line	:	391 LEE BLVD STE 200
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4973
Country	:	US
Telephone Number	:	239-344-9236
Fax Number	:	239-790-1408

Provider Business Practice Location Address
First Line	:	391 LEE BLVD STE 200
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4973
Country	:	US
Telephone Number	:	239-344-9236
Fax Number	:	239-790-1408

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ IDELSIS SERRANO ” Practice Location

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