MEDICARE: CARMEN A. SERRANO-LOPEZ MD

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	173000000X	Legal Medicine	ME74936	FL
2	207R00000X	Internal Medicine Physician	ME74936	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME74936	OTHER	FL	VHN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821067851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN A. SERRANO-LOPEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 9671
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32120-9671
Country	:	US
Telephone Number	:	386-615-4015
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4901
Country	:	US
Telephone Number	:	386-763-1000
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	06/05/2019

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