Provider Demographics
NPI:1235636440
Name:MITCHELL, MALLORY JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:JANE
Last Name:MITCHELL
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 1:1405 ROCKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9682
Mailing Address - Country:US
Mailing Address - Phone:209-380-1574
Mailing Address - Fax:
Practice Address - Street 1:1405 ROCKHAVEN DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9682
Practice Address - Country:US
Practice Address - Phone:209-380-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program