Provider Demographics
NPI:1962913426
Name:MITCHELL, ELAINE MARY (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:MARY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HAIR RESTORATION
Mailing Address - Street 1:4931 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113
Mailing Address - Country:US
Mailing Address - Phone:619-302-2404
Mailing Address - Fax:
Practice Address - Street 1:8818 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5407
Practice Address - Country:US
Practice Address - Phone:619-302-2404
Practice Address - Fax:619-262-6115
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management