Healthcare Provider Details

I. General information

NPI: 1649225558
Provider Name (Legal Business Name): FELICIANO ANTONIO SERRANO II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
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

7429 3RD ST
DOWNEY CA
90241-3211
US

V. Phone/Fax

Practice location:
  • Phone: 323-585-6900
  • Fax:
Mailing address:
  • Phone: 562-688-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA88849
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA88849
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA88849
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA88849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: