Provider Demographics
NPI:1215267471
Name:FELICIANO SERRANO, M.D., INC.
Entity type:Organization
Organization Name:FELICIANO SERRANO, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIANO
Authorized Official - Middle Name:R
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-585-6900
Mailing Address - Street 1:7305 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5736
Mailing Address - Country:US
Mailing Address - Phone:323-585-6900
Mailing Address - Fax:323-585-6962
Practice Address - Street 1:7305 PACIFIC BLVD FL 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5736
Practice Address - Country:US
Practice Address - Phone:323-585-6900
Practice Address - Fax:323-585-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACQ092AOtherMEDICARE PTAN
CACQ092AOtherMEDICARE PTAN