MEDICARE: FELICIANO SERRANO, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RN0300X	Nephrology Physician
3	2086S0129X	Vascular Surgery Physician
4	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CQ092A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1215267471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FELICIANO SERRANO, M.D., INC.

Provider Business Mailing Address
First Line	:	7305 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5736
Country	:	US
Telephone Number	:	323-585-6900
Fax Number	:	323-585-6962

Provider Business Practice Location Address
First Line	:	7305 PACIFIC BLVD FL 2
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5736
Country	:	US
Telephone Number	:	323-585-6900
Fax Number	:	323-585-6962

Authorized Official
Title or Position	:	BILLING MANAGEMENT
Name	:	MRS. FELICIANO R SERRANO
Credential	:
Telephone Number	:	323-585-6900

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	10/19/2020

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Directions to “FELICIANO SERRANO, M.D., INC. ” Practice Location

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