Healthcare Provider Details

I. General information

NPI: 1093092785
Provider Name (Legal Business Name): HARRY MITTELMAN MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 ALTOS OAKS DR
LOS ALTOS CA
94024-5403
US

IV. Provider business mailing address

810 ALTOS OAKS DR
LOS ALTOS CA
94024-5403
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-8888
  • Fax: 650-386-6800
Mailing address:
  • Phone: 650-941-8888
  • Fax: 650-386-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC30674
License Number StateCA

VIII. Authorized Official

Name: HARRY MITTELMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 650-941-8888