Provider Demographics
NPI:1962637967
Name:VALLEJO-NIETO, MARIA ALEJANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:VALLEJO-NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5012 S US HWY 75, SUITE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-2650
Mailing Address - Fax:
Practice Address - Street 1:2907 OVERLAND TRL STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4498
Practice Address - Country:US
Practice Address - Phone:903-416-2650
Practice Address - Fax:903-416-2651
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2998783-05Medicaid
TX2998783-05Medicaid
TXTXB155959Medicare PIN