Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G57538 | CA |
Y | 111NI0900X | Internist | G57538 | CA |
N | 207RN0300X | Nephrologist | G57538 | CA |
NPI | 1013996172 |
---|---|
Provider Name | Matthew G Mischel |
First Address | Van Nuys, CA 91411-2546 |
Second Address | Van Nuys, CA 91405-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G575380 | (05) | CA |
E93203 | (02) | CA |