Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 25506 | CA |
Y | 213ER0200X | Radiology | 25506 | CA |
NPI | 1649392572 |
---|---|
Provider Name | Dr. Jose L Serrano |
First Address | Huntington Beach, CA 92647-7110 |
Second Address | Huntington Beach, CA 92647-7110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |