Healthcare Provider Details

I. General information

NPI: 1922079433
Provider Name (Legal Business Name): JOSEFA MUNDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSEFA MERCEDES MUNDO GUZMAN M.D.

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RIVERS AVE BOX 487 NAVHOSP
NORTH CHARLESTON SC
29405-7747
US

IV. Provider business mailing address

3600 RIVERS AVE BOX 487 NAVHOSP
NORTH CHARLESTON SC
29405-7747
US

V. Phone/Fax

Practice location:
  • Phone: 732-272-6307
  • Fax:
Mailing address:
  • Phone: 732-272-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number5849
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: