Provider Demographics
NPI:1639992076
Name:MUNDH NP & GARRETSON MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:MUNDH NP & GARRETSON MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:530-701-3131
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-0008
Mailing Address - Country:US
Mailing Address - Phone:530-617-2071
Mailing Address - Fax:
Practice Address - Street 1:2794 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2255
Practice Address - Country:US
Practice Address - Phone:530-695-6830
Practice Address - Fax:530-237-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty