Healthcare Provider Details

I. General information

NPI: 1437644853
Provider Name (Legal Business Name): KATHERINE SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 N MOPAC EXPY
AUSTIN TX
78758-2414
US

IV. Provider business mailing address

12319 N MOPAC EXPY
AUSTIN TX
78758-2414
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-5577
  • Fax: 512-836-0166
Mailing address:
  • Phone: 512-835-5577
  • Fax: 512-836-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberT2496
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10063872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: