Healthcare Provider Details

I. General information

NPI: 1699777250
Provider Name (Legal Business Name): MARIE SALMERON-SERRANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 FM 1960 RD W 100
HOUSTON TX
77065-3827
US

IV. Provider business mailing address

PO BOX 841969
DALLAS TX
75284-1969
US

V. Phone/Fax

Practice location:
  • Phone: 281-970-2337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK0554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: