Provider Demographics
NPI:1720159247
Name:SERRANO-OJEDA, PEDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:SERRANO-OJEDA
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:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0958
Mailing Address - Country:US
Mailing Address - Phone:787-993-2800
Mailing Address - Fax:
Practice Address - Street 1:3125 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1994
Practice Address - Country:US
Practice Address - Phone:305-436-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014754261QX0203X
FLME78916261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015098800Medicaid
FLIF267ZMedicare PIN
PRCW613ZMedicare PIN