Provider Demographics
NPI:1164827846
Name:SERNA, LETICIA MEDRANO (PA-C)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MEDRANO
Last Name:SERNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 STARR ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2711
Mailing Address - Country:US
Mailing Address - Phone:956-514-1643
Mailing Address - Fax:956-514-2564
Practice Address - Street 1:208 STARR ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2711
Practice Address - Country:US
Practice Address - Phone:956-514-1643
Practice Address - Fax:956-514-2564
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09075363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical