MEDICARE: JOSUE EMANUEL SERRANO

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	174400000X	Specialist

General Provider Information

NPI Number	:	1407002819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSUE EMANUEL SERRANO

Provider Business Mailing Address
First Line	:	616 SR 436 STE 105
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4811
Country	:	US
Telephone Number	:	321-307-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 SR 436 STE 105
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4811
Country	:	US
Telephone Number	:	321-307-0048
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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Directions to “ JOSUE EMANUEL SERRANO ” Practice Location

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