Doctor Name: | DR. CHRISTOPHER JAN MUNDALE |
NPI Number: | 1013927748 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PSY 16147 |
Business Practice Address: | 10 Corporate Park Suite 215 Irvine, CA - 926065140 |
Business Phone Number: | 9493987900 |
Business Fax Number: | 9493987901 |
Mailing Address: | 10 Corporate Park, Suite 215 IRVINE |
State: | CA |
Postal Code: | 926065140 |
Phone Number: | 9493987900 |
Fax Number: | 9493987901 |
NPI Enumeration Date: | 08/08/2006 |
NPI Last Update Date: | 12/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 16147 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |