Healthcare Provider Details

I. General information

NPI: 1942203013
Provider Name (Legal Business Name): JUDY T DEL MUNDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 CLARMAR WAY STE A
SAN JOSE CA
95128-1706
US

IV. Provider business mailing address

2061 CLARMAR WAY STE A
SAN JOSE CA
95128-1706
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-8807
  • Fax: 408-271-9814
Mailing address:
  • Phone: 408-271-8807
  • Fax: 408-271-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA64233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: