Provider Demographics
NPI:1124223250
Name:SERRANO MEDINA, NITZA MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:NITZA
Middle Name:MERCEDES
Last Name:SERRANO MEDINA
Suffix:
Gender:F
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:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-1765
Mailing Address - Country:US
Mailing Address - Phone:787-594-3204
Mailing Address - Fax:
Practice Address - Street 1:1507 AVE PONCE DE LEON APT 205
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2050
Practice Address - Country:US
Practice Address - Phone:787-201-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty