Provider Demographics
NPI:1609530252
Name:MITCHELL, STEVEN (DRIVER)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DRIVER
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FAMILIES AGAINST MET
Mailing Address - Street 1:4889 STREAMBAY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5130
Mailing Address - Country:US
Mailing Address - Phone:951-230-9156
Mailing Address - Fax:
Practice Address - Street 1:4889 STREAMBAY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5130
Practice Address - Country:US
Practice Address - Phone:951-230-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-5613115Medicaid