Provider Demographics
NPI:1285050450
Name:JOHN H MITCHELL MD INC
Entity type:Organization
Organization Name:JOHN H MITCHELL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-996-2390
Mailing Address - Street 1:2874 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6714
Mailing Address - Country:US
Mailing Address - Phone:714-996-2390
Mailing Address - Fax:714-996-2301
Practice Address - Street 1:2874 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6714
Practice Address - Country:US
Practice Address - Phone:714-996-2390
Practice Address - Fax:714-996-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225024912OtherNPI
CAA90004Medicare UPIN
CAWA425001Medicare PIN