Provider Demographics
NPI:1649225558
Name:SERRANO, FELICIANO ANTONIO II (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIANO
Middle Name:ANTONIO
Last Name:SERRANO
Suffix:II
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 1:7429 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3211
Mailing Address - Country:US
Mailing Address - Phone:562-688-2589
Mailing Address - Fax:
Practice Address - Street 1:7305 PACIFIC BLVD FL 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5736
Practice Address - Country:US
Practice Address - Phone:323-585-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88849207R00000X, 207RN0300X, 2086S0129X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACQ095ZOtherMEDICARE PTAN
CACQ095ZOtherMEDICARE PTAN