Provider Demographics
NPI:1154358497
Name:AMOR S DEL MUNDO MD, INC.
Entity type:Organization
Organization Name:AMOR S DEL MUNDO MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEL MUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-310-0798
Mailing Address - Street 1:PO BOX 2786
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 S PROSPECT AVE
Practice Address - Street 2:SUITE # 140 B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3698
Practice Address - Country:US
Practice Address - Phone:714-508-6791
Practice Address - Fax:714-508-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC505312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505310Medicaid
CAC50531AMedicare ID - Type Unspecified
CA00C505310Medicaid