Provider Demographics
NPI:1215018460
Name:MITRA, MITALI SATHI (MD)
Entity Type:Individual
Prefix:
First Name:MITALI
Middle Name:SATHI
Last Name:MITRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MITALI
Other - Middle Name:
Other - Last Name:DATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1161 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4607
Mailing Address - Country:US
Mailing Address - Phone:520-570-1460
Mailing Address - Fax:
Practice Address - Street 1:3818 W 16TH ST BLDG 5
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4107
Practice Address - Country:US
Practice Address - Phone:928-317-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ356002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry