MEDICARE: LUIS A SERRANO M. D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	6176	PR

General Provider Information

NPI Number	:	1235132713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS A SERRANO M. D.

Provider Business Mailing Address
First Line	:	44 MAYOR ST.
Second Line	:	ZAMORA BUILDING 1ST. FLOOR
City	:	PONCE
State	:	PR
Zip	:	00730-3761
Country	:	US
Telephone Number	:	787-848-5353
Fax Number	:	787-259-4462

Provider Business Practice Location Address
First Line	:	44 MAYOR ST.
Second Line	:	ZAMORA BUILDING 1ST. FLOOR
City	:	PONCE
State	:	PR
Zip	:	00730-3761
Country	:	US
Telephone Number	:	787-848-5353
Fax Number	:	787-259-4462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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