Provider Demographics
NPI:1346308228
Name:MITCHELL, GAYLE V (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:V
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2728
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-8728
Mailing Address - Country:US
Mailing Address - Phone:323-316-9461
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:STE 1200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-523-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667120Medicaid
CAA66712Medicare ID - Type Unspecified
CAH16549Medicare UPIN