=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376634113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMOR S. DEL MUNDO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 S PROSPECT AVE SUITE 140 B
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-3698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-310-0798
-----------------------------------------------------
Fax | 714-508-6791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2786
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90632-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-310-0798
-----------------------------------------------------
Fax | 714-508-6791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C50531
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------