Provider Demographics
NPI:1639941032
Name:MITCHELL, AMBER (CHW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 UNIVERSITY AVE # F-508
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4467
Mailing Address - Country:US
Mailing Address - Phone:626-712-5902
Mailing Address - Fax:
Practice Address - Street 1:1450 UNIVERSITY AVE # F-508
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4467
Practice Address - Country:US
Practice Address - Phone:626-712-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker