Active NPI
Abdias Joel De la Rosa Serrano, MD
- Family Medicine Physician
- Florida, PR
National Provider Identifier
1124234471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 16145
- Practice address
- Street 140 KM 56.3 Bo. la Vazquez Florida P.R 00650
Florida, PR 00650-0038 - Phone
- (787) 380-0775
- NPI assigned
- May 15, 2007
- Last updated
- Oct 2, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16145 | PR | Primary |
Addresses
Primary practice location
Street 140 KM 56.3 Bo. la Vazquez Florida P.R 00650
Florida, PR 00650-0038
Mailing address
3381 Phillis Blvd
Myrtle Beach, SC 29577-1560
Phone (843) 477-0177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151104000379 | SC | Order and Referring Only - Family Practice | 4385784453 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16145 | PR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443744000000",
"number": "1124234471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3381 PHILLIS BLVD",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295771560",
"telephone_number": "843-477-0177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STREET 140 KM 56.3 BO. LA VAZQUEZ FLORIDA P.R 00650",
"city": "FLORIDA",
"state": "PR",
"postal_code": "006500038",
"telephone_number": "787-380-0775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA ROSA SERRANO",
"first_name": "ABDIAS",
"middle_name": "JOEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2015-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PR",
"license": "16145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florida, PR
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- Farmacia CDT Policlinica Familiar Florida
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.