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General NPI Number Information
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NPI Number | 1194160804
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Entity Type | Individual
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Provider Name | RYAN M. SERRANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 877-558-6248
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1026
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1026
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Country | US
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Telephone | 317-777-6435
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Fax | 317-777-6644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 01076880A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | A134638
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License Number State | CA
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