Provider Demographics
NPI:1942055991
Name:SERRA, EDGAR JOSE
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JOSE
Last Name:SERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 TALISI LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9167
Mailing Address - Country:US
Mailing Address - Phone:689-299-5161
Mailing Address - Fax:
Practice Address - Street 1:561 TALISI LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9167
Practice Address - Country:US
Practice Address - Phone:689-299-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program