Healthcare Provider Details

I. General information

NPI: 1235589599
Provider Name (Legal Business Name): RAFAEL SERRANO RIERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date: 02/02/2017
Reactivation Date: 03/09/2017

III. Provider practice location address

1731 W RIDGEWAY AVE STE 600
WATERLOO IA
50701-4594
US

IV. Provider business mailing address

1731 W RIDGEWAY AVE STE 600
WATERLOO IA
50701-4594
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5961
  • Fax:
Mailing address:
  • Phone: 319-833-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD49693
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: