Provider Demographics
NPI:1295625689
Name:SERRANO, DESIREE MICHELLE (LAC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MICHELLE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 SE DIVISION ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1689
Mailing Address - Country:US
Mailing Address - Phone:619-804-5994
Mailing Address - Fax:
Practice Address - Street 1:4927 NE 30TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7007
Practice Address - Country:US
Practice Address - Phone:503-281-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC226315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist