MEDICARE: DR. FELICIANO ANTONIO SERRANO II 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	207R00000X	Internal Medicine Physician	A88849	CA
2	207RN0300X	Nephrology Physician	A88849	CA
3	2086S0129X	Vascular Surgery Physician	A88849	CA
4	174400000X	Specialist	A88849	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CQ095Z	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1649225558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELICIANO ANTONIO SERRANO II M.D.

Provider Business Mailing Address
First Line	:	7429 3RD ST
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-3211
Country	:	US
Telephone Number	:	562-688-2589
Fax Number	:

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	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/15/2020

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