Healthcare Provider Details

I. General information

NPI: 1063998615
Provider Name (Legal Business Name): JAMES F MITCHELL JR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD STE 205
VENTURA CA
93003
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-3086
  • Fax:
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG46712
License Number StateCA

VIII. Authorized Official

Name: JAMES F MITCHELL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 805-886-8193