Healthcare Provider Details

I. General information

NPI: 1861764532
Provider Name (Legal Business Name): CARMEN NICOLE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BERCUT DR
SACRAMENTO CA
95811-0131
US

IV. Provider business mailing address

600 BERCUT DR
SACRAMENTO CA
95811-0131
US

V. Phone/Fax

Practice location:
  • Phone: 916-440-1500
  • Fax:
Mailing address:
  • Phone: 916-440-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: