Healthcare Provider Details

I. General information

NPI: 1164678926
Provider Name (Legal Business Name): JOSE LUIS SERRANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIA 39 4XS-13 VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

VIA 39 4XS-13 VILLA FONTANA
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-236-1623
  • Fax:
Mailing address:
  • Phone: 787-236-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18169
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18169
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: