Healthcare Provider Details

I. General information

NPI: 1093709743
Provider Name (Legal Business Name): EDNA SERRANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL CENTRO MEDICO PUERTO RICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

65 CALLE SAUCO CIUDAD JARDIN # 3
TOA ALTA PR
00953-4863
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-2705
  • Fax:
Mailing address:
  • Phone: 787-810-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10111
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number10111
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10111
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10111
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: