Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | C1422548 | CA |
N | 207SG0201X | Clinical Genetics (M.D.) | MT194028 | PA |
N | 208000000X | Pediatrician | 39570 | IA |
N | 208D00000X | General Practice Physician | MD436046 | PA |
NPI | 1306076039 |
---|---|
Provider Name | Alvaro H Serrano Russi |
First Address | Los Angeles, CA 90010-2814 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 30/11/2016 |