Provider Demographics
NPI:1730598004
Name:SERRANO LOPEZ, PABLO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:ANTONIO
Last Name:SERRANO LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1706 S ALEXANDER ST STE B
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8411
Mailing Address - Country:US
Mailing Address - Phone:813-717-9000
Mailing Address - Fax:813-717-9005
Practice Address - Street 1:1706 S ALEXANDER ST STE B
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8411
Practice Address - Country:US
Practice Address - Phone:813-717-9000
Practice Address - Fax:813-717-9005
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18836208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice