Basic Information
| Provider Information | |||||||||
| NPI: | 1639530397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KUNJANA MAVUNDA MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SW 122ND ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331565549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056680075 | ||||||||
| FaxNumber: | 3056686299 | ||||||||
| Practice Location | |||||||||
| Address1: | 6280 SW 72ND ST | ||||||||
| Address2: | SUITE 607 | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056680075 | ||||||||
| FaxNumber: | 3056686299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | MAVUNDA | ||||||||
| AuthorizedOfficialFirstName: | KUNJANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3056680075 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME47855 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.