Provider Demographics
NPI:1073820320
Name:SERRANO, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A5 CALLE CAMPECHE
Mailing Address - Street 2:QUINTAS DE SAN LUIS II
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7607
Mailing Address - Country:US
Mailing Address - Phone:787-747-1650
Mailing Address - Fax:
Practice Address - Street 1:A5 CALLE CAMPECHE
Practice Address - Street 2:QUINTAS DE SAN LUIS II
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7607
Practice Address - Country:US
Practice Address - Phone:787-747-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR020569261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health