Provider Demographics
NPI:1578547857
Name:SERRANO, JOHNNY LEON (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:LEON
Last Name:SERRANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4706
Mailing Address - Country:US
Mailing Address - Phone:602-547-3300
Mailing Address - Fax:602-547-3302
Practice Address - Street 1:5310 W THUNDERBIRD RD
Practice Address - Street 2:STE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4706
Practice Address - Country:US
Practice Address - Phone:602-547-3300
Practice Address - Fax:602-547-3302
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18064Medicare UPIN
74549Medicare ID - Type Unspecified