Healthcare Provider Details

I. General information

NPI: 1881620433
Provider Name (Legal Business Name): MARINEL M MUNDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINEL MUNDA PAMATMAT MD

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 5TH ST
TYLER TX
75701-3315
US

IV. Provider business mailing address

1000 E 5TH ST
TYLER TX
75701-3346
US

V. Phone/Fax

Practice location:
  • Phone: 903-590-5555
  • Fax: 903-590-5005
Mailing address:
  • Phone: 903-596-3588
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: