Healthcare Provider Details

I. General information

NPI: 1578472791
Provider Name (Legal Business Name): PAUL MITTERMILLER, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 5TH ST STE 300
SANTA MONICA CA
90401-1433
US

IV. Provider business mailing address

13157 MINDANAO WAY # 581
MARINA DEL REY CA
90292-6307
US

V. Phone/Fax

Practice location:
  • Phone: 858-255-4223
  • Fax: 910-335-8228
Mailing address:
  • Phone: 858-255-4223
  • Fax: 910-335-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL MITTERMILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 858-255-4223