Provider Demographics
NPI:1457985541
Name:SERRANO VIRUET, DIMARIS (MD)
Entity type:Individual
Prefix:
First Name:DIMARIS
Middle Name:
Last Name:SERRANO VIRUET
Suffix:
Gender:F
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:HC 4 BOX 14604
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO. CARRERAS 1, CARR 123
Practice Address - Street 2:SECTOR JAGUAR
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9247
Practice Address - Country:US
Practice Address - Phone:787-376-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice