Provider Demographics
NPI:1821671421
Name:SERRANO, JOSE (MEDICAL ASSITANT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:MEDICAL ASSITANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16637 INYO ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4819
Mailing Address - Country:US
Mailing Address - Phone:626-494-8046
Mailing Address - Fax:
Practice Address - Street 1:115 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2144
Practice Address - Country:US
Practice Address - Phone:877-225-0316
Practice Address - Fax:877-225-0316
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical