Provider Demographics
NPI:1407357114
Name:MUNDIN, JOANN (MD, FRCPC, MSC, DABP)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:MUNDIN
Suffix:
Gender:F
Credentials:MD, FRCPC, MSC, DABP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 MCKINNEY ST # 19887
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6308
Mailing Address - Country:US
Mailing Address - Phone:702-613-1270
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL STE 224
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1458
Practice Address - Country:US
Practice Address - Phone:702-613-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV195382084P0800X
WY14028A2084P0800X
NVAF000062084P0800X
CAC1739412084P0800X
IDM-158992084P0800X
TXT31432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry