Provider Demographics
NPI:1326236365
Name:MITRA, AVIJIT (CPO)
Entity Type:Individual
Prefix:
First Name:AVIJIT
Middle Name:
Last Name:MITRA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ABLE ORTHO CLINIC INC
Mailing Address - Street 2:475 W. STETSON AVE. SUITE C
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-2631
Mailing Address - Country:US
Mailing Address - Phone:951-929-5000
Mailing Address - Fax:951-929-5033
Practice Address - Street 1:475 W STETSON AVE STE C
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7073
Practice Address - Country:US
Practice Address - Phone:951-929-5000
Practice Address - Fax:951-929-5033
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist