Provider Demographics
NPI:1891675500
Name:SERRANO, RAMON (LMT MA95991)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:LMT MA95991
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 WOODLAKE CIR APT 166
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4328
Mailing Address - Country:US
Mailing Address - Phone:813-455-7505
Mailing Address - Fax:
Practice Address - Street 1:3874 WOODLAKE CIR APT 166
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4328
Practice Address - Country:US
Practice Address - Phone:813-455-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist