Provider Demographics
NPI:1053551978
Name:SERRANZANA, JEANETTE PONTILLANO
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:PONTILLANO
Last Name:SERRANZANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 PEACEKEEPER WAY
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2609
Mailing Address - Country:US
Mailing Address - Phone:818-602-2394
Mailing Address - Fax:916-929-1861
Practice Address - Street 1:3230 PEACEKEEPER WAY
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2609
Practice Address - Country:US
Practice Address - Phone:818-602-2394
Practice Address - Fax:916-929-1861
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse