Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | AP145199 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP145199 | TX |
NPI | 1467086967 |
---|---|
Provider Name | Ralph Serenio |
First Address | Pearland, TX 77584-3468 |
Second Address | Houston, TX 77030-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 26/08/2021 |