Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 131445 | CA |
N | 208600000X | Surgeon | 131445 | CA |
Y | 208200000X | Surgeon | MD463917 | PA |
Y | 208600000X | Surgeon | MD463917 | PA |
NPI | 1003222381 |
---|---|
Provider Name | Mr. Derek Ray Serna-Gallegos |
First Address | Pittsburgh, PA 15213 |
Second Address | Pittsburgh, PA 15232-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 09/04/2020 |