Provider Demographics
NPI:1457080061
Name:NOBRIGA, MITCHELL ALLEN (STUDENT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALLEN
Last Name:NOBRIGA
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 LEFEVRE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6193
Mailing Address - Country:US
Mailing Address - Phone:916-947-3262
Mailing Address - Fax:
Practice Address - Street 1:534 LEFEVRE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6193
Practice Address - Country:US
Practice Address - Phone:916-947-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant