Healthcare Provider Details

I. General information

NPI: 1518027630
Provider Name (Legal Business Name): SIDNEY MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: S TODD MITCHELL MD

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 SUMMIT ROAD
WATSONVILLE CA
95076
US

IV. Provider business mailing address

445 SUMMIT ROAD
WATSONVILLE CA
95076
US

V. Phone/Fax

Practice location:
  • Phone: 831-479-7916
  • Fax:
Mailing address:
  • Phone: 831-479-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG59020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG59020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: