Healthcare Provider Details

I. General information

NPI: 1356359764
Provider Name (Legal Business Name): DAVID J MOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST SUITE 301
MIAMI FL
33150-2063
US

IV. Provider business mailing address

1130 TEN ROD RD D201
NORTH KINGSTOWN RI
02852-4161
US

V. Phone/Fax

Practice location:
  • Phone: 305-904-3490
  • Fax: 305-535-0931
Mailing address:
  • Phone: 401-295-8655
  • Fax: 401-295-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG9880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: