Provider Demographics
NPI:1275850588
Name:MUNDO, JENNY (BA)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:MUNDO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 SAINT ESTABAN ST
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-3135
Mailing Address - Country:US
Mailing Address - Phone:818-497-5385
Mailing Address - Fax:
Practice Address - Street 1:6919 SAINT ESTABAN ST
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-3135
Practice Address - Country:US
Practice Address - Phone:818-497-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner