MEDICARE: ANDRES RAUL ANDINO SERRANO M.PSY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	004195	PR
2	103TC1900X	Counseling Psychologist	005172	PR

General Provider Information

NPI Number	:	1417379405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES RAUL ANDINO SERRANO M.PSY

Provider Business Mailing Address
First Line	:	PO BOX 604
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0604
Country	:	US
Telephone Number	:	787-220-1272
Fax Number	:

Provider Business Practice Location Address
First Line	:	CONCORDIA SHOPPING CENTER
Second Line	:	AVE. 65TH INFANTERIA BO. SABANA LLANA SUR
City	:	SAN JUAN
State	:	PR
Zip	:	00924-0000
Country	:	US
Telephone Number	:	787-220-1272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	08/25/2025

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