Basic Information
| Provider Information | |||||||||
| NPI: | 1376697698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONDZELEWSKI | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38400 BOB WILSON DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921340001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014040019 | ||||||||
| FaxNumber: | 6195327272 | ||||||||
| Practice Location | |||||||||
| Address1: | 34800 BOB WILSON DR | ||||||||
| Address2: | OPHTHALMOLOGY DEPARTMENT | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921341098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326700 | ||||||||
| FaxNumber: | 6195327272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 01059689A | IN | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.