Provider Demographics
NPI:1235132713
Name:SERRANO, LUIS A (M D)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:SERRANO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAYOR ST.
Mailing Address - Street 2:ZAMORA BUILDING 1ST. FLOOR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3761
Mailing Address - Country:US
Mailing Address - Phone:787-848-5353
Mailing Address - Fax:787-259-4462
Practice Address - Street 1:44 MAYOR ST.
Practice Address - Street 2:ZAMORA BUILDING 1ST. FLOOR
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3761
Practice Address - Country:US
Practice Address - Phone:787-848-5353
Practice Address - Fax:787-259-4462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6176207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE11480Medicare UPIN
PR0027537Medicare ID - Type Unspecified