Healthcare Provider Details

I. General information

NPI: 1912756362
Provider Name (Legal Business Name): MITCHELL D CLAIRE PHYSICIAN ASSISTANT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 ROSS AVE STE D
EL CENTRO CA
92243-4371
US

IV. Provider business mailing address

14120 ALONDRA BLVD STE C
SANTA FE SPRINGS CA
90670-5842
US

V. Phone/Fax

Practice location:
  • Phone: 760-636-2091
  • Fax:
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL D CLAIRE
Title or Position: OWNER
Credential:
Phone: 760-636-2091