Provider Demographics
NPI:1114771516
Name:MITRA, SUMITA (DO)
Entity Type:Individual
Prefix:
First Name:SUMITA
Middle Name:
Last Name:MITRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 HAYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3226
Mailing Address - Country:US
Mailing Address - Phone:818-389-9647
Mailing Address - Fax:
Practice Address - Street 1:4396 HAYMAN AVE
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3226
Practice Address - Country:US
Practice Address - Phone:818-389-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program