Provider Demographics
NPI:1548422009
Name:SERRANO, RAUL JOSE (DC)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:JOSE
Last Name:SERRANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 EDENTON WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2537
Mailing Address - Country:US
Mailing Address - Phone:813-748-3601
Mailing Address - Fax:
Practice Address - Street 1:10981 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2630
Practice Address - Country:US
Practice Address - Phone:813-855-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor