MEDICARE: DR. NOEL 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	207R00000X	Internal Medicine Physician	036-112248	IL
2	207R00000X	Internal Medicine Physician	A108658	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-112248	OTHER	IL	LIC PHY

General Provider Information

NPI Number	:	1700925211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOEL SERRANO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 16309
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-6309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6117 FAIRLANE DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-1807
Country	:	US
Telephone Number	:	707-535-9279
Fax Number	:	707-303-8301

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	01/14/2026

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