Provider Demographics
NPI:1982630174
Name:DEL MUNDO, VENERANDO R (MD)
Entity Type:Individual
Prefix:
First Name:VENERANDO
Middle Name:R
Last Name:DEL MUNDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:STE 550
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2332
Mailing Address - Country:US
Mailing Address - Phone:318-212-3681
Mailing Address - Fax:318-212-3687
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:STE 550
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2332
Practice Address - Country:US
Practice Address - Phone:318-212-3681
Practice Address - Fax:318-212-3687
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578096Medicaid
LA1578096Medicaid
LA4E733Medicare PIN
LA4E733CM25Medicare PIN
LA4E733CP87Medicare PIN
LA362265YJBAMedicare PIN