Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 0101036268 | VA |
Y | 2084N0402X | Child Neurologist | G12577 | CA |
NPI | 1033204581 |
---|---|
Provider Name | Dr. Michael Hewitt Mitchell |
First Address | Ventura, CA 93003-7672 |
Second Address | Ventura, CA 93003-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101036268 | STATE LICENSE (01) | VA |