Provider Demographics
NPI:1013927748
Name:MUNDALE, CHRISTOPHER JAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAN
Last Name:MUNDALE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE PARK
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5140
Mailing Address - Country:US
Mailing Address - Phone:949-398-7900
Mailing Address - Fax:949-398-7901
Practice Address - Street 1:10 CORPORATE PARK
Practice Address - Street 2:SUITE 215
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5140
Practice Address - Country:US
Practice Address - Phone:949-398-7900
Practice Address - Fax:949-398-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical