Provider Demographics
NPI:1275807703
Name:FOBBS-MITCHELL, INGRID (NP)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:FOBBS-MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12209
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2209
Mailing Address - Country:US
Mailing Address - Phone:909-427-9960
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 240
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8082
Practice Address - Country:US
Practice Address - Phone:909-427-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily