Healthcare Provider Details

I. General information

NPI: 1699859652
Provider Name (Legal Business Name): WENDY G MITCHELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD. MS# 82
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6430 SUNSET BLVD. SUITE 600
LOS ANGELES CA
90028-7900
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2471
  • Fax: 323-361-1109
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA91072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: