Individual provider Active NPI

Juan Adolfo Serna

  • Contractor
  • Tucson, AZ
National Provider Identifier
1609240118
Registry record updated Nov 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ContractorTaxonomy code 171W00000X
License
7166916 Issued in AZ
Practice address
9985 E Rocky Vista Dr
Tucson, AZ 85748-7880
Phone
(520) 302-1712
Fax
(520) 750-0056
NPI assigned
Nov 20, 2015
Last updated
Nov 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X 7166916 AZ Primary

Addresses

Primary practice location

9985 E Rocky Vista Dr
Tucson, AZ 85748-7880

Mailing address

870 W Miracle Mile
Tucson, AZ 85705-3708
Phone (520) 750-9667

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7166916AZMDContractor

NPI Registry JSON

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

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447977600000",
    "number": "1609240118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 W MIRACLE MILE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857053708",
            "telephone_number": "520-750-9667",
            "fax_number": "520-750-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9985 E ROCKY VISTA DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857487880",
            "telephone_number": "520-302-1712",
            "fax_number": "520-750-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERNA",
        "first_name": "JUAN",
        "middle_name": "ADOLFO",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-20",
        "last_updated": "2015-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "AZ",
            "license": "7166916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; 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.