Provider Demographics
NPI:1164776068
Name:MUNDO, FABRICIO
Entity Type:Individual
Prefix:MR
First Name:FABRICIO
Middle Name:
Last Name:MUNDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19887 NORTHCLIFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351
Mailing Address - Country:US
Mailing Address - Phone:661-313-0546
Mailing Address - Fax:775-806-0374
Practice Address - Street 1:19887 NORTHCLIFF DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351
Practice Address - Country:US
Practice Address - Phone:661-313-0546
Practice Address - Fax:775-806-0374
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter