Provider Demographics
NPI:1730239120
Name:MONDRAGON, RINA CECILLE
Entity type:Individual
Prefix:MS
First Name:RINA
Middle Name:CECILLE
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11154 THUNDERHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4582
Mailing Address - Country:US
Mailing Address - Phone:281-955-5645
Mailing Address - Fax:
Practice Address - Street 1:11154 THUNDERHAVEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4582
Practice Address - Country:US
Practice Address - Phone:281-955-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging