Provider Demographics
NPI:1962688325
Name:MITCHELL A. ADLER, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MITCHELL A. ADLER, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-934-4245
Mailing Address - Street 1:1300 E CYPRESS ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4728
Mailing Address - Country:US
Mailing Address - Phone:805-922-8006
Mailing Address - Fax:
Practice Address - Street 1:1300 E CYPRESS ST
Practice Address - Street 2:BUILDING B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4728
Practice Address - Country:US
Practice Address - Phone:805-922-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF92470Medicare UPIN
CAW18630Medicare PIN