Provider Demographics
NPI:1891842670
Name:MITCHELL, ANITHA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:THERESA
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 1:211 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1412
Mailing Address - Country:US
Mailing Address - Phone:310-673-9499
Mailing Address - Fax:310-677-5643
Practice Address - Street 1:211 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1412
Practice Address - Country:US
Practice Address - Phone:310-673-9499
Practice Address - Fax:310-677-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35006Medicare UPIN