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General NPI Number Information
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NPI Number | 1013110121
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Entity Type | Individual
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Provider Name | DIANNE ILENE MITCHELL DPM
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Gender | Female
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 3000 Q ST 4TH FLOOR PODIATRY
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City | SACRAMENTO
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State | CA
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Zip | 95816-7058
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Country | US
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Telephone | 916-733-3359
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Fax | 916-733-3462
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Provider Business Mailing Address
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Address Line | 3000 Q ST 4TH FLOOR PODIATRY
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City | SACRAMENTO
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State | CA
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Zip | 95816-7058
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Country | US
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Telephone | 916-733-3359
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Fax | 916-733-3462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO00000826
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E-4683
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License Number State | CA
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