Provider Demographics
NPI:1124234471
Name:DE LA ROSA SERRANO, ABDIAS JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDIAS
Middle Name:JOEL
Last Name:DE LA ROSA SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 PHILLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1560
Mailing Address - Country:US
Mailing Address - Phone:843-477-0177
Mailing Address - Fax:
Practice Address - Street 1:STREET 140 KM 56.3 BO. LA VAZQUEZ FLORIDA P.R 00650
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-0038
Practice Address - Country:US
Practice Address - Phone:787-380-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine