MEDICARE: DR. MANELYS ACOSTA SERRANO M.D.

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	208D00000X	General Practice Physician	014299-I	PR
2	207R00000X	Internal Medicine Physician	R0172	TX

General Provider Information

NPI Number	:	1841538352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANELYS ACOSTA SERRANO M.D.

Provider Business Mailing Address
First Line	:	VA BALCONES HEIGHTS 4522 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6521
Country	:	US
Telephone Number	:	210-732-1802
Fax Number	:

Provider Business Practice Location Address
First Line	:	BALCONES HEIGHTS VA CLINIC 4522 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6521
Country	:	US
Telephone Number	:	210-732-1802
Fax Number	:

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

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	03/11/2020

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