Healthcare Provider Details

I. General information

NPI: 1851319057
Provider Name (Legal Business Name): MARIA-GISELA MERCADO-DEANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

PO BOX 12507
SAN ANTONIO TX
78212-0507
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-2467
  • Fax: 903-617-5247
Mailing address:
  • Phone: 210-704-2467
  • Fax: 903-617-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35-086062
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberK9129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: