Active NPI
Edgar Eduardo Serrano
- Speech-Language Pathologist
- Mesa, AZ
National Provider Identifier
1629609599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- TSLP12040
- Practice address
- 345 S Hall
Mesa, AZ 85204-2409 - Phone
- (480) 472-6562
- NPI assigned
- Jan 30, 2020
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | TSLP12040 | AZ | Primary |
Addresses
Primary practice location
345 S Hall
Mesa, AZ 85204-2409
Mailing address
7118 E Bell Cir
Mesa, AZ 85208-1010
Phone (480) 740-8740
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
| License | State | Type | Specialty |
|---|---|---|---|
| TSLP12040 | AZ | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Casa Speech Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Hearing and Speech Clinic/Center
- Chandler, AZ
- NPI 1255801114
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697068800000",
"number": "1629609599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7118 E BELL CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852081010",
"telephone_number": "480-740-8740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 S HALL",
"city": "MESA",
"state": "AZ",
"postal_code": "852042409",
"telephone_number": "480-472-6562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRANO",
"first_name": "EDGAR",
"middle_name": "EDUARDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-30",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "TSLP12040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.