Provider Demographics
NPI:1164610325
Name:SHEILAJA MITTAL M D PROF CORP
Entity Type:Organization
Organization Name:SHEILAJA MITTAL M D PROF CORP
Other - Org Name:WORKWELL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-533-5353
Mailing Address - Street 1:1172 S. MAIN ST.
Mailing Address - Street 2:#380
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2204
Mailing Address - Country:US
Mailing Address - Phone:831-553-5353
Mailing Address - Fax:831-536-1859
Practice Address - Street 1:1172 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-422-3701
Practice Address - Fax:831-536-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66313207Q00000X
CAA76569207R00000X
2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A765690Medicaid
CA105990300OtherDEPT OF LABOR
11372513OtherCAQH
CAZZZ27066ZMedicare PIN
CA00A765690Medicaid