O Serrano Md Pllc | |
218 W White Mountain Blvd Suite C Lakeside AZ 85929-7013 | |
(928) 367-3637 | |
(928) 367-3638 |
Full Name | O Serrano Md Pllc |
---|---|
Speciality | Internal Medicine - Gastroenterology |
Location | 218 W White Mountain Blvd, Lakeside, Arizona |
Authorized Official Name and Position | Oluwagbenga Serrano (OWNER) |
Authorized Official Contact | 9283673637 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
O Serrano Md Pllc Po Box 1149 Lakeside AZ 85929-1149 Ph: (928) 367-3637 | O Serrano Md Pllc 218 W White Mountain Blvd Suite C Lakeside AZ 85929-7013 Ph: (928) 367-3637 |
NPI Number | 1104978600 |
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Provider Enumeration Date | 01/17/2007 |
Last Update Date | 01/13/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104978600 | NPI | - | NPPES |
025539 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | 29877 (Arizona) | Primary |
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