Healthcare Provider Details

I. General information

NPI: 1982741500
Provider Name (Legal Business Name): JOSEPH L SERRANO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 EAGLE ROCK BLVD SUITE 7
LOS ANGELES CA
90065-4492
US

IV. Provider business mailing address

4157 EAGLE ROCK BLVD SUITE 7
LOS ANGELES CA
90065-4492
US

V. Phone/Fax

Practice location:
  • Phone: 323-982-1566
  • Fax: 323-982-1680
Mailing address:
  • Phone: 323-982-1566
  • Fax: 323-982-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: