Provider Demographics
NPI:1649276916
Name:ADLER, MITCHELL A (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:A
Last Name:ADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-922-8006
Mailing Address - Fax:805-922-0184
Practice Address - Street 1:116 S PALISADE DR STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-922-8006
Practice Address - Fax:805-922-0184
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72287207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G722870Medicaid
WG7287GMedicare PIN
CAF92470Medicare UPIN