Provider Demographics
NPI:1245426048
Name:DEL MUNDO, JENNIFER LAZARRAGA
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LAZARRAGA
Last Name:DEL MUNDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 E SCOTTS VW UNIT D
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-7571
Mailing Address - Country:US
Mailing Address - Phone:714-340-8279
Mailing Address - Fax:
Practice Address - Street 1:17621 IRVINE BLVD STE 216
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3131
Practice Address - Country:US
Practice Address - Phone:714-340-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA53993106H00000X
CA29261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist