Basic Information
| Provider Information | |||||||||
| NPI: | 1669553749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEL MUNDO | ||||||||
| FirstName: | CECILE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 MEMORIAL DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409626196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065985104 | ||||||||
| FaxNumber: | 6065980983 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 CUMBERLAND GAP PLZ | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407344536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065269005 | ||||||||
| FaxNumber: | 6065268607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD0000035243 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35193 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4046372 | 05 | TN | MEDICAID | 64994569 | 05 | KY | MEDICAID | 6499456900 | 05 | KY | MEDICAID |