Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 10111 | PR |
Y | 2080A0000X | Adolescent Medicine | 10111 | PR |
NPI | 1093709743 |
---|---|
Provider Name | Edna Serrano |
First Address | Toa Alta, PR 00953-4863 |
Second Address | San Juan, PR 00936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 29/05/2014 |