Provider Demographics
NPI:1285630350
Name:SERRANO, ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
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:EST-GRAN-VISTA # 1 SAN-FRANCISCO
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5085
Mailing Address - Country:US
Mailing Address - Phone:787-736-2224
Mailing Address - Fax:
Practice Address - Street 1:COLON # 53
Practice Address - Street 2:
Practice Address - City:SAN-LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9334207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081588Medicare ID - Type UnspecifiedMEDICARE