1174844435 NPI number — MRS. NICOLE ANAIS MITCHELL CATC III

Table of content: MRS. NICOLE ANAIS MITCHELL CATC III (NPI 1174844435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174844435 NPI number — MRS. NICOLE ANAIS MITCHELL CATC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
NICOLE
Provider Middle Name:
ANAIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CATC III
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174844435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
832 COLINA VISTA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-642-7033
Provider Business Mailing Address Fax Number:
805-642-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5810 RALSTON ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-642-7033
Provider Business Practice Location Address Fax Number:
805-642-7732
Provider Enumeration Date:
06/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 174400000X . This is a "OTHER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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