Healthcare Provider Details

I. General information

NPI: 1811656085
Provider Name (Legal Business Name): ALFREDO SERRANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 11/05/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W OCEAN BLVD
LOS FRESNOS TX
78566-3637
US

IV. Provider business mailing address

104 ALVAREZ CT
LOS FRESNOS TX
78566-3214
US

V. Phone/Fax

Practice location:
  • Phone: 956-233-3443
  • Fax:
Mailing address:
  • Phone: 956-590-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1060861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: