Provider Demographics
NPI:1912756362
Name:MITCHELL D CLAIRE PHYSICIAN ASSISTANT PC
Entity type:Organization
Organization Name:MITCHELL D CLAIRE PHYSICIAN ASSISTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-636-2091
Mailing Address - Street 1:14120 ALONDRA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-5842
Mailing Address - Country:US
Mailing Address - Phone:562-407-2080
Mailing Address - Fax:562-407-2082
Practice Address - Street 1:1073 ROSS AVE STE D
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4371
Practice Address - Country:US
Practice Address - Phone:760-636-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant