Provider Demographics
NPI:1750327698
Name:SERRANO MEDICAL EQUIPMENT AND SUPPLIS
Entity Type:Organization
Organization Name:SERRANO MEDICAL EQUIPMENT AND SUPPLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEMPTEE FOR DME
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAMAE
Authorized Official - Middle Name:TORREDA
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECHNICIAN
Authorized Official - Phone:909-981-7022
Mailing Address - Street 1:521 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5098
Mailing Address - Country:US
Mailing Address - Phone:909-981-7022
Mailing Address - Fax:909-982-2757
Practice Address - Street 1:521 N MOUNTAIN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5098
Practice Address - Country:US
Practice Address - Phone:909-981-7022
Practice Address - Fax:909-982-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDNG332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies