Healthcare Provider Details

I. General information

NPI: 1669553749
Provider Name (Legal Business Name): CECILE DEL MUNDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 100
HAZARD KY
41701-9524
US

IV. Provider business mailing address

PO BOX 1988
HAZARD KY
41702-1988
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1300
  • Fax: 606-439-1400
Mailing address:
  • Phone: 606-439-1300
  • Fax: 606-439-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000035243
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35193
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: