Provider Demographics
NPI:1831114743
Name:SERFINO, LEONARDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:C
Last Name:SERFINO
Suffix:
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 1:1951 N WILMOT RD
Mailing Address - Street 2:BLDG. 1, STE. 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:1590 PASEO SAN LUIS
Practice Address - Street 2:STE 101
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4782
Practice Address - Country:US
Practice Address - Phone:520-220-5711
Practice Address - Fax:520-220-5709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ154086OtherIND. PTAN
AZ736598Medicaid
AZZ154087OtherGROUP PTAN
AZ706110Medicaid
AZ706110Medicaid