Provider Demographics
NPI:1326124660
Name:SERRANO-CANCINO, HECTOR J (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:J
Last Name:SERRANO-CANCINO
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 1:1378 CORAL WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2943
Mailing Address - Country:US
Mailing Address - Phone:305-285-0996
Mailing Address - Fax:866-571-2719
Practice Address - Street 1:1378 CORAL WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2943
Practice Address - Country:US
Practice Address - Phone:305-285-0996
Practice Address - Fax:866-571-2719
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036873207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63637Medicare UPIN
FL95848Medicare ID - Type Unspecified