Provider Demographics
NPI:1366449001
Name:TINDALL, MARISEL BEATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISEL
Middle Name:BEATRIZ
Last Name:TINDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISEL
Other - Middle Name:
Other - Last Name:CANCEL-MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3711 OWL CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-4450
Mailing Address - Country:US
Mailing Address - Phone:210-315-4056
Mailing Address - Fax:
Practice Address - Street 1:700 S ZARZAMORA ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-543-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871966135Medicaid
TX044717902Medicaid
TX044717902Medicaid
H00420Medicare UPIN