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General NPI Number Information
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NPI Number | 1851319057
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Entity Type | Individual
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Provider Name | MARIA-GISELA MERCADO-DEANE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 333 N SANTA ROSA ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3108
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Country | US
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Telephone | 210-704-2467
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Fax | 903-617-5247
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Provider Business Mailing Address
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Address Line | PO BOX 12507
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City | SAN ANTONIO
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State | TX
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Zip | 78212-0507
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Country | US
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Telephone | 210-704-2467
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Fax | 903-617-5247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 35-086062
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | K9129
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License Number State | TX
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