Abdias Joel De la Rosa Serrano, MD
Individual provider Active NPI Family Medicine Physician · Florida, PR
NPI 1124234471 · NPPES record last updated Oct 2, 2015
Key facts
- NPI
- 1124234471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 16145 (PR)
- 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
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151104000379 | SC | Order and Referring Only - Family Practice |
4385784453 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16145 | PR | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16145 | PR | Yes |
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
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.