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General NPI Number Information
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NPI Number | 1265593222
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Entity Type | Individual
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Provider Name | JORGE A MUNDO MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | CALLE ANTONIO LOPEZ #114
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-850-6005
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Fax | 787-852-5449
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | JUNCOS
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State | PR
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Zip | 00777-1447
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Country | US
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Telephone | 787-850-6005
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Fax | 787-852-5449
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 8410
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License Number State | PR
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