Healthcare Provider Details

I. General information

NPI: 1619214749
Provider Name (Legal Business Name): S T MITCHELL M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 SUMMIT RD
WATSONVILLE CA
95076-9781
US

IV. Provider business mailing address

445 SUMMIT RD
WATSONVILLE CA
95076-9781
US

V. Phone/Fax

Practice location:
  • Phone: 831-227-6048
  • Fax:
Mailing address:
  • Phone: 831-227-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. S TODD MITCHELL
Title or Position: PRESIDENT
Credential: MD
Phone: 831-227-6048