Active NPI
Edward Refugio Serros, MD
- Nephrology Physician
- Highland, CA
National Provider Identifier
1386665024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G30299
- Practice address
- 7223 Church St
Suite a-20
Highland, CA 92346-5869 - Phone
- (909) 882-0702
- Fax
- (909) 886-6704
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G30299 | CA | Primary |
Addresses
Primary practice location
7223 Church St
Suite a-20
Highland, CA 92346-5869
Mailing address
7223 Church St
Suite a-20
Highland, CA 92346-5869
Phone (909) 882-0702
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G302990 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30299 | CA | MD | Chiropractor |
| G30299 | CA | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411948800000",
"number": "1386665024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7223 CHURCH ST",
"address_2": "SUITE A-20",
"city": "HIGHLAND",
"state": "CA",
"postal_code": "923465869",
"telephone_number": "909-882-0702",
"fax_number": "909-886-6704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7223 CHURCH ST",
"address_2": "SUITE A-20",
"city": "HIGHLAND",
"state": "CA",
"postal_code": "923465869",
"telephone_number": "909-882-0702",
"fax_number": "909-886-6704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERROS",
"first_name": "EDWARD",
"middle_name": "REFUGIO",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2014-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G30299",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G302990",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Highland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.