MEDICARE: DR H V MUNGCAL MD, INC

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	208D00000X	General Practice Physician	A49333	CA

General Provider Information

NPI Number	:	1306884945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR H V MUNGCAL MD, INC

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	:

Provider Business Practice Location Address
First Line	:	2139 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3121
Country	:	US
Telephone Number	:	562-243-8895
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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