Provider Demographics
NPI:1922170398
Name:MITCHELL, MARIA CECILIA (RPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LOOP 289
Mailing Address - Street 2:STE 3
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407
Mailing Address - Country:US
Mailing Address - Phone:806-792-7125
Mailing Address - Fax:806-792-7121
Practice Address - Street 1:1901 W LOOP 289
Practice Address - Street 2:STE 3
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407
Practice Address - Country:US
Practice Address - Phone:806-792-7125
Practice Address - Fax:806-792-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0043163332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84220TOtherBCBS
TX84220TOtherBCBS
83095EMedicare Oscar/Certification