Provider Demographics
NPI:1740487453
Name:MITCHELL, GEORGE EDWARD (LAC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:DOC
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:222 OAK MEADOW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4458
Mailing Address - Country:US
Mailing Address - Phone:408-399-7711
Mailing Address - Fax:408-399-7707
Practice Address - Street 1:222 OAK MEADOW DR
Practice Address - Street 2:SUITE B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4458
Practice Address - Country:US
Practice Address - Phone:408-399-7711
Practice Address - Fax:408-399-7707
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist