Provider Demographics
NPI:1922079433
Name:MUNDO, JOSEFA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFA
Middle Name:
Last Name:MUNDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSEFA
Other - Middle Name:MERCEDES
Other - Last Name:MUNDO GUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 RIVERS AVE
Mailing Address - Street 2:BOX 487 NAVHOSP
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7747
Mailing Address - Country:US
Mailing Address - Phone:732-272-6307
Mailing Address - Fax:
Practice Address - Street 1:3600 RIVERS AVE
Practice Address - Street 2:BOX 487 NAVHOSP
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7747
Practice Address - Country:US
Practice Address - Phone:732-272-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5849171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider