Provider Demographics
NPI:1972660280
Name:DAVID M. MITZNER D.O. INC.
Entity Type:Organization
Organization Name:DAVID M. MITZNER D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MITZNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-506-5768
Mailing Address - Street 1:27625 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2619
Mailing Address - Country:US
Mailing Address - Phone:951-506-5768
Mailing Address - Fax:951-506-0356
Practice Address - Street 1:27625 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2619
Practice Address - Country:US
Practice Address - Phone:951-506-5768
Practice Address - Fax:951-506-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020A58980Medicare ID - Type Unspecified
CAF16790Medicare UPIN