Provider Demographics
NPI:1275594244
Name:MORALES SERRANO, EDGARDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:MORALES SERRANO
Suffix:
Gender:M
Credentials:DPM
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 2582
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2582
Mailing Address - Country:US
Mailing Address - Phone:787-975-8192
Mailing Address - Fax:787-975-8193
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:LAS AMERICAS PROFESSIONAL CENTER SUITE 306
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-975-8192
Practice Address - Fax:787-975-8193
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR099213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
53469Medicare ID - Type Unspecified
U91419Medicare UPIN