Individual Professional Information |
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NPI
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1649225558
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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3173588787
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20041123000571
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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SERRANO
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Individual professional last name
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Provider First Name
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FELICIANO
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Individual professional first name
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Provider Middle Name
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A
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Individual professional middle name
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Provider Name Suffix Text
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II
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The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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Provider Gender
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M
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The provider's gender if the provider is a person.
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Provider Credential Text
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MD
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The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
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Medical School Information |
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Medical School Name
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UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
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Individual professional's medical school
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Graduation Year
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2002
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Individual professional's medical school graduation year
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Primary Specialty
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NEPHROLOGY
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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INTERNAL MEDICINE
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First secondary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 2
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VASCULAR SURGERY
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Second secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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INTERNAL MEDICINE, VASCULAR SURGERY
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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