Provider Demographics
NPI:1942597034
Name:MITRE, SIXTO VINCE
Entity Type:Individual
Prefix:
First Name:SIXTO
Middle Name:VINCE
Last Name:MITRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S EL CIELO RD STE EF
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7926
Mailing Address - Country:US
Mailing Address - Phone:760-416-1753
Mailing Address - Fax:
Practice Address - Street 1:400 S EL CIELO RD STE EF
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7926
Practice Address - Country:US
Practice Address - Phone:760-416-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator