Basic Information
| Provider Information | |||||||||
| NPI: | 1356359764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOND | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 TEN ROD RD | ||||||||
| Address2: | D201 | ||||||||
| City: | NORTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028524161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012958655 | ||||||||
| FaxNumber: | 4012958335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 NW 95TH ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331502063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059043490 | ||||||||
| FaxNumber: | 3055350931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | G9880 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 379593400 | 05 | FL | MEDICAID |