MEDICARE: HENRICO V. MUNGCAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A49333	CA

General Provider Information

NPI Number	:	1255386215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRICO V. MUNGCAL MD

Provider Business Mailing Address
First Line	:	PO BOX 6129
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-0129
Country	:	US
Telephone Number	:	562-243-8895
Fax Number	:	562-591-7306

Provider Business Practice Location Address
First Line	:	1937 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5321
Country	:	US
Telephone Number	:	562-243-8895
Fax Number	:	562-591-7306

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. HENRICO V. MUNGCAL
Credential	:	M.D.
Telephone Number	:	562-243-8895

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/16/2008

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