Provider Demographics
NPI:1265481766
Name:REYES-SERRANO, MARIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:REYES-SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19832 NW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6206
Mailing Address - Country:US
Mailing Address - Phone:305-816-5956
Mailing Address - Fax:305-816-5976
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 311
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-271-6570
Practice Address - Fax:305-279-6805
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6453BMedicare PIN
FLU6453Medicare PIN