MEDICARE: MR. VICTOR 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	171W00000X	Contractor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1730511783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR SERRANO

Provider Business Mailing Address
First Line	:	4621 NW SANTA FE AVE
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-3257
Country	:	US
Telephone Number	:	580-230-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	4621 NW SANTA FE AVE
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-3257
Country	:	US
Telephone Number	:	580-230-4443
Fax Number	:

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/16/2021

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Directions to “ MR. VICTOR SERRANO ” Practice Location

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