Healthcare Provider Details

I. General information

NPI: 1417056987
Provider Name (Legal Business Name): MITCHELL RAY RICE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 MOUNT EVEREST BLVD
SAN DIEGO CA
92111-2625
US

IV. Provider business mailing address

4060 MT. EVEREST BLD
SAN DIEGO CA
92111
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-6315
  • Fax:
Mailing address:
  • Phone: 858-576-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number275200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number275299
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number275200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: