Healthcare Provider Details

I. General information

NPI: 1275594244
Provider Name (Legal Business Name): EDGARDO MORALES SERRANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE DOMENECH LAS AMERICAS PROFESSIONAL CENTER SUITE 306
SAN JUAN PR
00918-3710
US

IV. Provider business mailing address

PO BOX 2582
GUAYNABO PR
00970-2582
US

V. Phone/Fax

Practice location:
  • Phone: 787-975-8192
  • Fax: 787-975-8193
Mailing address:
  • Phone: 787-975-8192
  • Fax: 787-975-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number099
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: