Healthcare Provider Details

I. General information

NPI: 1922280619
Provider Name (Legal Business Name): RICARDO A SERRANO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FORTENBERRY RD
MERRITT ISLAND FL
32952-3616
US

IV. Provider business mailing address

30 FORTENBERRY RD
MERRITT ISLAND FL
32952-3616
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-2267
  • Fax: 321-453-8019
Mailing address:
  • Phone: 321-453-2267
  • Fax: 321-453-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0069902
License Number StateFL

VIII. Authorized Official

Name: RICARDO A SERRANO
Title or Position: OWNER & MD
Credential: MD
Phone: 321-453-2267