1962913426 NPI number — MRS. ELAINE MARY MITCHELL CERTIFIED HAIR LOSS

Table of content: MRS. ELAINE MARY MITCHELL CERTIFIED HAIR LOSS (NPI 1962913426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962913426 NPI number — MRS. ELAINE MARY MITCHELL CERTIFIED HAIR LOSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
ELAINE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED HAIR LOSS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
ELAINE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HAIR RESTORATION
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962913426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4931 OCEAN VIEW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-302-2404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8818 LA MESA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-5407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-302-2404
Provider Business Practice Location Address Fax Number:
619-262-6115
Provider Enumeration Date:
10/23/2017

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: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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