Healthcare Provider Details

I. General information

NPI: 1699067918
Provider Name (Legal Business Name): PABLO SERRANO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 GROSSMONT CENTER DR STE 141
LA MESA CA
91942-3070
US

IV. Provider business mailing address

5500 GROSSMONT CENTER DR STE 141
LA MESA CA
91942-3070
US

V. Phone/Fax

Practice location:
  • Phone: 619-433-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: