Individual
CARLY MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
499 LOMA ALTA AVE, LOS GATOS, CA 95030-6227
(408) 335-1832
Mailing address
499 LOMA ALTA AVE, LOS GATOS, CA 95030-6227
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41095
UNICARE
CA
Enumeration date
01/03/2007
Last updated
07/08/2007
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