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General NPI Number Information
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NPI Number | 1003886847
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Entity Type | Organization
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Legal Business Name | RENATO V MUNGCAL, MD-A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 133 S. VERMONT AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90004-5904
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Country | US
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Telephone | 213-480-0748
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Fax | 213-480-1661
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Provider Business Mailing Address
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Address Line | 133 S. VERMONT AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90004-5904
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Country | US
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Telephone | 213-480-0748
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Fax | 213-480-1661
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Authorized Official
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Title or Position | SOLE OWNER/PRESIDENT
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Name | RENATO VALONDO MUNGCAL
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Credential | M.D.
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Telephone | 213-480-0748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A42598
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License Number State | CA
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