Healthcare Provider Details

I. General information

NPI: 1245153790
Provider Name (Legal Business Name): MITCHELL TOWNSEND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MITCHELL SHAW

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 ROBERT J MATHEWS PKWY
EL DORADO HILLS CA
95762-5705
US

IV. Provider business mailing address

7028 KINGSMILL WAY
CITRUS HEIGHTS CA
95610-3333
US

V. Phone/Fax

Practice location:
  • Phone: 279-356-6957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberL10176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: