Healthcare Provider Details

I. General information

NPI: 1962030718
Provider Name (Legal Business Name): MITCHELL PAUL ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 S MANTHEY RD
FRENCH CAMP CA
95231-9518
US

IV. Provider business mailing address

6505 S MANTHEY RD
FRENCH CAMP CA
95231-9518
US

V. Phone/Fax

Practice location:
  • Phone: 800-382-8387
  • Fax:
Mailing address:
  • Phone: 800-382-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA176484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: