Provider Demographics
NPI:1982186508
Name:MUNDH, HARDEEP
Entity Type:Individual
Prefix:
First Name:HARDEEP
Middle Name:
Last Name:MUNDH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9792 LIVE OAK BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2381
Mailing Address - Country:US
Mailing Address - Phone:530-701-3131
Mailing Address - Fax:530-237-0460
Practice Address - Street 1:9792 LIVE OAK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2381
Practice Address - Country:US
Practice Address - Phone:530-701-3131
Practice Address - Fax:530-237-0460
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS643AMedicaid