Healthcare Provider Details

I. General information

NPI: 1215267471
Provider Name (Legal Business Name): FELICIANO SERRANO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 PACIFIC BLVD FL 2
HUNTINGTON PARK CA
90255-5736
US

IV. Provider business mailing address

7305 PACIFIC BLVD
HUNTINGTON PARK CA
90255-5736
US

V. Phone/Fax

Practice location:
  • Phone: 323-585-6900
  • Fax: 323-585-6962
Mailing address:
  • Phone: 323-585-6900
  • Fax: 323-585-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FELICIANO R SERRANO
Title or Position: BILLING MANAGEMENT
Credential:
Phone: 323-585-6900