Provider Demographics
NPI:1346527785
Name:MUNDELL, DERINDA (FIRST ASSISTANT)
Entity type:Individual
Prefix:
First Name:DERINDA
Middle Name:
Last Name:MUNDELL
Suffix:
Gender:F
Credentials:FIRST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N LOOP 1604 E
Mailing Address - Street 2:7105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1276
Mailing Address - Country:US
Mailing Address - Phone:210-316-9797
Mailing Address - Fax:
Practice Address - Street 1:215 N LOOP 1604 E
Practice Address - Street 2:7105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1276
Practice Address - Country:US
Practice Address - Phone:210-316-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant