Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1326236365 |
---|---|
Provider Name | Avijit Mitra |
First Address | Hemet, CA 92543-2631 |
Second Address | Hemet, CA 92543-7073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 08/08/2017 |