Basic Information
| Provider Information | |||||||||
| NPI: | 1477661940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERRANO | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 NW 30TH CT | ||||||||
| Address2: | |||||||||
| City: | WILTON MANORS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333111719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055190383 | ||||||||
| FaxNumber: | 8504318251 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 71ST ST | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331413038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | 3056143352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2006 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | PA9101369 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 291950800 | 05 | FL | MEDICAID |