Provider Demographics
NPI:1548428097
Name:CECILE C. DEL MUNDO, MD, PLLC
Entity Type:Organization
Organization Name:CECILE C. DEL MUNDO, MD, PLLC
Other - Org Name:PEDIATRIC AND ADOLESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEL MUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-330-0566
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1706
Mailing Address - Country:US
Mailing Address - Phone:606-330-0566
Mailing Address - Fax:606-330-0496
Practice Address - Street 1:202 W 7TH ST
Practice Address - Street 2:STE 201
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1763
Practice Address - Country:US
Practice Address - Phone:606-330-0566
Practice Address - Fax:606-330-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty