Provider Demographics
NPI:1679684286
Name:MUNDINE, SANDRA DENISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:DENISE
Last Name:MUNDINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 PECAN TREE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0702
Mailing Address - Country:US
Mailing Address - Phone:713-927-9680
Mailing Address - Fax:
Practice Address - Street 1:7968 ESSEN PARK
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7439
Practice Address - Country:US
Practice Address - Phone:225-761-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD168R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery