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NPI Code Detail

MEDICARE: ALLIFAIR RENEE MUNDINE

MEDICARE: ALLIFAIR RENEE MUNDINE
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
1390200000XStudent in an Organized Health Care Education/Training ProgramCO

General Provider Information

NPI Number : 1699618330
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIFAIR RENEE MUNDINE
Provider Business Mailing Address
First Line : 11188 CEDAR GLEN VW APT 305
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-7696
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7075 CAMPUS DR STE 202
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-6524
Country : US
Telephone Number : 719-888-6827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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Directions to “ ALLIFAIR RENEE MUNDINE ” Practice Location

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