Active NPI
Lissette Diaz-Serrano
- General Practice Physician
- Chicago, IL
National Provider Identifier
1730755380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 22344
- Practice address
- 2053 W Birchwood Ave Apt 3
Chicago, IL 60645-2173 - Phone
- (773) 706-6197
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Physician | 208D00000X | 22344 | PR | Primary |
Addresses
Primary practice location
2053 W Birchwood Ave Apt 3
Chicago, IL 60645-2173
Mailing address
2053 W Birchwood Ave Apt 3
Chicago, IL 60645-2173
Phone (773) 706-6197
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 |
|---|---|---|---|
| 22344 | PR | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745280000000",
"number": "1730755380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2053 W BIRCHWOOD AVE APT 3",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606452173",
"telephone_number": "773-706-6197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2053 W BIRCHWOOD AVE APT 3",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606452173",
"telephone_number": "773-706-6197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ-SERRANO",
"first_name": "LISSETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-02",
"last_updated": "2025-04-22",
"certification_date": "2025-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "22344",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.