Healthcare Provider Details

I. General information

NPI: 1427605997
Provider Name (Legal Business Name): SERGIO SERPA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WINTER ST
BOSTON MA
02108-4720
US

IV. Provider business mailing address

30 WINTER ST
BOSTON MA
02108-4720
US

V. Phone/Fax

Practice location:
  • Phone: 866-610-2273
  • Fax:
Mailing address:
  • Phone: 866-610-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2270469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: