Provider Demographics
NPI:1770525784
Name:SERRANO, NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
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:PO BOX 1826
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1826
Mailing Address - Country:US
Mailing Address - Phone:787-859-4377
Mailing Address - Fax:787-859-0396
Practice Address - Street 1:7 CALLE GANDARA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1984
Practice Address - Country:US
Practice Address - Phone:787-859-4377
Practice Address - Fax:787-859-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE65314Medicare UPIN
PR29630Medicare ID - Type Unspecified