Healthcare Provider Details

I. General information

NPI: 1235717935
Provider Name (Legal Business Name): ORLANDO MUNDO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CERRA 900 SAN JUAN
SAN JUAN PR
00907-0090
US

IV. Provider business mailing address

PO BOX 21405
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-340-1446
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-340-1446
  • Fax: 787-723-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number73296
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: