Healthcare Provider Details

I. General information

NPI: 1235116542
Provider Name (Legal Business Name): MIM I MULFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 230
MISSION VIEJO CA
92691-8038
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 230
MISSION VIEJO CA
92691-8038
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-8004
  • Fax: 949-364-3682
Mailing address:
  • Phone: 949-542-8004
  • Fax: 949-364-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG79494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: