Provider Demographics
NPI:1265593222
Name:MUNDO, JORGE A (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name: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:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1447
Mailing Address - Country:US
Mailing Address - Phone:787-850-6005
Mailing Address - Fax:787-852-5449
Practice Address - Street 1:CALLE ANTONIO LOPEZ #114
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-6005
Practice Address - Fax:787-852-5449
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8410207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44009Medicare UPIN
80904Medicare ID - Type Unspecified