Healthcare Provider Details

I. General information

NPI: 1740338672
Provider Name (Legal Business Name): JAMES JOSEPH MITCHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 FAIRWAY VIEW PL
RANCHO CUCAMONGA CA
91730-0932
US

IV. Provider business mailing address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-7345
  • Fax: 909-484-8661
Mailing address:
  • Phone: 626-851-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG62397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: