Provider Demographics
NPI:1154366870
Name:SERRALTA, VICTORIA W (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:W
Last Name:SERRALTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:WATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8015 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7018
Mailing Address - Country:US
Mailing Address - Phone:817-453-4440
Mailing Address - Fax:817-453-7755
Practice Address - Street 1:8015 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-7018
Practice Address - Country:US
Practice Address - Phone:817-453-4440
Practice Address - Fax:817-453-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1338207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0095Medicare ID - Type Unspecified