Oluwagbenga Serrano

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

29877 Issued in AZ

Legal business name

OLUWAGBENGA SERRANO

Practice address

218 W White Mountain Blvd
Suite C
Lakeside, AZ 85929-7013

Phone

(928) 367-3637

Fax

(928) 367-3638

NPI assigned

Jan 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Oluwagbenga Serrano, M.D.

Title

Owner

Phone

(928) 367-3637

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• O Serrano MD PLLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1104978600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1149",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859291149",
            "telephone_number": "928-367-3637",
            "fax_number": "928-367-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 W WHITE MOUNTAIN BLVD",
            "address_2": "SUITE C",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297013",
            "telephone_number": "928-367-3637",
            "fax_number": "928-367-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLUWAGBENGA SERRANO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "SERRANO",
        "authorized_official_first_name": "OLUWAGBENGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-367-3637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "29877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025539",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "O Serrano MD PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Lakeside, AZ
• Gastroenterology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.