Provider Demographics
NPI:1780883058
Name:SERRANO, DAVID (AMFT130317)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:AMFT130317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 S GLESS ST # 321A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-3702
Mailing Address - Country:US
Mailing Address - Phone:323-868-2238
Mailing Address - Fax:
Practice Address - Street 1:381 S GLESS ST # 321A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3702
Practice Address - Country:US
Practice Address - Phone:323-868-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 225400000X
CAAMFT130317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner