Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35193 | KY |
N | 208000000X | Pediatrician | MD0000035243 | TN |
NPI | 1669553749 |
---|---|
Provider Name | Cecile Del Mundo |
First Address | Manchester, KY 40962-6196 |
Second Address | Gray, KY 40734-4536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4046372 | (05) | TN |
64994569 | (05) | KY |
6499456900 | (05) | KY |
H28203 | (02) |