Healthcare Provider Details

I. General information

NPI: 1124223250
Provider Name (Legal Business Name): NITZA MERCEDES SERRANO MEDINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 AVE PONCE DE LEON APT 205
SAN JUAN PR
00909-2050
US

IV. Provider business mailing address

PO BOX 1765
DORADO PR
00646-1765
US

V. Phone/Fax

Practice location:
  • Phone: 787-201-6246
  • Fax:
Mailing address:
  • Phone: 787-594-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17323
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: