Individual
S TODD MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
445 SUMMIT ROAD, WATSONVILLE, CA 95076
(831) 479-7916
Mailing address
445 SUMMIT ROAD, WATSONVILLE, CA 95076
(831) 479-7916
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G59020
CA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
G59020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G590200
—
CA
01
—
080051612
RR MEDICARE
CA
Enumeration date
12/11/2006
Last updated
01/09/2013
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