Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | C161065 | CA |
NPI | 1225233760 |
---|---|
Provider Name | Dr. Katrina Blackburn Mitchell |
First Address | Santa Barbara, CA 93160-2106 |
Second Address | Santa Barbara, CA 93105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
346373901 | (05) | TX |