Healthcare Provider Details

I. General information

NPI: 1851717714
Provider Name (Legal Business Name): MARK 'MARKOS' SERROS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PAN AMERICAN FREEWAY #108
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

4302 PAN AMERICAN FWY NE APT 108
ALBUQUERQUE NM
87107-4708
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-3989
  • Fax:
Mailing address:
  • Phone: 505-974-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number7844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: