Healthcare Provider Details

I. General information

NPI: 1396732442
Provider Name (Legal Business Name): GUSTAVO SERRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 N ARMENIA AVE SUITE A
TAMPA FL
33603-1405
US

IV. Provider business mailing address

5101 N ARMENIA AVE SUITE A
TAMPA FL
33603-1405
US

V. Phone/Fax

Practice location:
  • Phone: 831-870-6477
  • Fax: 813-870-6567
Mailing address:
  • Phone: 831-870-6477
  • Fax: 813-870-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0065536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: