Healthcare Provider Details

I. General information

NPI: 1598143406
Provider Name (Legal Business Name): MIGUEL A SERRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-3300
US

IV. Provider business mailing address

34800 BOB WILSON DR (NAVAL MEDICAL CTR - DMH)
SAN DIEGO CA
92134-3300
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6210
  • Fax: 619-532-6212
Mailing address:
  • Phone: 619-532-6210
  • Fax: 619-532-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA147642
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: