Provider Demographics
NPI:1689912230
Name:SERRANO, MARCO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2415
Mailing Address - Country:US
Mailing Address - Phone:909-489-7478
Mailing Address - Fax:
Practice Address - Street 1:1306 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2415
Practice Address - Country:US
Practice Address - Phone:909-489-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant