Healthcare Provider Details

I. General information

NPI: 1154010072
Provider Name (Legal Business Name): NOEL SERRANO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 FAIRLANE DR
OAKLAND CA
94611-1807
US

IV. Provider business mailing address

PO BOX 16309
JACKSONVILLE FL
32245-6309
US

V. Phone/Fax

Practice location:
  • Phone: 707-535-9279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NOEL SERRANO
Title or Position: OWNER
Credential: MD
Phone: 707-535-9279