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General NPI Number Information
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NPI Number | 1841892650
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Entity Type | Individual
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Provider Name | NELSON SERRANO FNP
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 15995 TUSCOLA RD STE 203
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2159
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Country | US
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Telephone | 760-242-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 11949 HESPERIA RD STE B
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City | HESPERIA
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State | CA
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Zip | 92345-2181
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Country | US
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Telephone | 760-242-5111
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015885
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License Number State | CA
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