Healthcare Provider Details

I. General information

NPI: 1699744805
Provider Name (Legal Business Name): GLORY M SERRANO MD PEDIATRICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SUNNY HILLS B 1 AVE SANTA JUANITA
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 26
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-288-7920
  • Fax:
Mailing address:
  • Phone: 787-288-7920
  • Fax: 787-288-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13803
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: