Provider Demographics
NPI:1245206465
Name:SERRANO, PABLO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0067
Mailing Address - Country:US
Mailing Address - Phone:787-850-2555
Mailing Address - Fax:787-850-4991
Practice Address - Street 1:54 CALLE MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3645
Practice Address - Country:US
Practice Address - Phone:787-850-2555
Practice Address - Fax:787-850-4991
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9456207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA-78360Medicare UPIN
PR8-1364Medicare ID - Type Unspecified