Healthcare Provider Details

I. General information

NPI: 1063075836
Provider Name (Legal Business Name): MARISELA FRANCES MARISCAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 E BROADWAY BLVD
TUCSON AZ
85711
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 520-613-3001
  • Fax:
Mailing address:
  • Phone: 615-315-5257
  • Fax: 615-692-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR77415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: