Provider Demographics
NPI:1558500876
Name:REBECCA DI MUNDO, M.D., INC
Entity Type:Organization
Organization Name:REBECCA DI MUNDO, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-829-3525
Mailing Address - Street 1:2210 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 00
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2313
Mailing Address - Country:US
Mailing Address - Phone:310-829-3525
Mailing Address - Fax:310-829-7437
Practice Address - Street 1:2210 SANTA MONICA BLVD
Practice Address - Street 2:00
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2313
Practice Address - Country:US
Practice Address - Phone:310-829-3525
Practice Address - Fax:310-829-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty