Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 200400322 | NC |
Y | 207RI0011X | Interventional Cardiology | 200400322 | NC |
NPI | 1093923187 |
---|---|
Provider Name | Fernando A. De La Serna |
First Address | Morganton, NC 28655-4093 |
Second Address | Morganton, NC 28655-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 13/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093923187 | (05) | NC |
5906733 | (05) | NC |
Q22004 | (05) | SC |