Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G55867 | CA |
NPI | 1366501967 |
---|---|
Provider Name | Michael L. Mitchell |
First Address | Baldwin Park, CA 91706-5806 |
Second Address | Baldwin Park, CA 91706-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 30/11/2021 |