Provider Demographics
NPI:1205830106
Name:FUNICELLA, TONI (MD)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:FUNICELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 RESEARCH BLVD
Mailing Address - Street 2:STE P4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1835
Mailing Address - Country:US
Mailing Address - Phone:512-250-5521
Mailing Address - Fax:512-250-2291
Practice Address - Street 1:13740 RESEARCH BLVD
Practice Address - Street 2:STE P4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1835
Practice Address - Country:US
Practice Address - Phone:512-250-5521
Practice Address - Fax:512-250-2291
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9447174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist