Provider Demographics
NPI:1700925211
Name:SERRANO, NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:SERRANO
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 1:6117 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1807
Mailing Address - Country:US
Mailing Address - Phone:707-535-9279
Mailing Address - Fax:707-303-8301
Practice Address - Street 1:6117 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1807
Practice Address - Country:US
Practice Address - Phone:707-535-9279
Practice Address - Fax:707-303-8301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112248207R00000X
CAA108658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112248OtherLIC PHY
CADK932YMedicare PIN