Provider Demographics
NPI:1306802459
Name:SERRANO-MERCADO, MAITEE SOLEDAD (MD)
Entity type:Individual
Prefix:DR
First Name:MAITEE
Middle Name:SOLEDAD
Last Name:SERRANO-MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAITEE
Other - Middle Name:SOLEDAD
Other - Last Name:SERRANO TOLEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5601 CENTRAL FWY
Mailing Address - Street 2:APT. # 1811
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76305-6609
Mailing Address - Country:US
Mailing Address - Phone:940-851-8042
Mailing Address - Fax:
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:SHEPPARD AFB
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-736-6855
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine