Healthcare Provider Details

I. General information

NPI: 1730138678
Provider Name (Legal Business Name): MITCHELL JOSEPH WAINWRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR STE 100
LADERA RANCH CA
92694-1153
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9112
  • Fax: 949-348-9513
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA41388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: