Provider Demographics
NPI:1376634113
Name:DEL MUNDO, AMOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOR
Middle Name:S
Last Name:DEL MUNDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2786
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2786
Mailing Address - Country:US
Mailing Address - Phone:714-310-0798
Mailing Address - Fax:714-508-6791
Practice Address - Street 1:180 S PROSPECT AVE
Practice Address - Street 2:SUITE 140 B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3698
Practice Address - Country:US
Practice Address - Phone:714-310-0798
Practice Address - Fax:714-508-6791
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC505312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505310Medicaid
CAC50531AMedicare ID - Type Unspecified
CA00C505310Medicaid