Provider Demographics
NPI:1407002819
Name:SERRANO, JOSUE EMANUEL
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:EMANUEL
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 SR 436 STE 105
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4811
Mailing Address - Country:US
Mailing Address - Phone:321-307-0048
Mailing Address - Fax:
Practice Address - Street 1:616 SR 436 STE 105
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4811
Practice Address - Country:US
Practice Address - Phone:321-307-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist