Provider Demographics
NPI:1699859652
Name:MITCHELL, WENDY G (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6430 SUNSET BLVD.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7900
Mailing Address - Country:US
Mailing Address - Phone:323-361-2337
Mailing Address - Fax:323-361-8491
Practice Address - Street 1:4650 SUNSET BLVD.
Practice Address - Street 2:MS# 82
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-2471
Practice Address - Fax:323-361-1109
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA910722084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G277250Medicaid
CA00G277250Medicaid
CAA91072Medicare UPIN