Healthcare Provider Details

I. General information

NPI: 1760432041
Provider Name (Legal Business Name): M. K. SERIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD CARDIOLOGY CLINIC
SALINAS CA
93906-3100
US

IV. Provider business mailing address

25990 ROTUNDA DR
CARMEL CA
93923-8967
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1630
  • Fax: 831-796-1616
Mailing address:
  • Phone: 831-796-1630
  • Fax: 831-372-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA47824
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA47824
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA47824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: