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General NPI Number Information
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NPI Number | 1790355899
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Entity Type | Organization
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Legal Business Name | SEVEN O ONE MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 701 N ALVARADO ST STE A
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City | LOS ANGELES
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State | CA
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Zip | 90026-4005
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Country | US
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Telephone | 213-302-2472
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N ALVARADO ST STE A
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City | LOS ANGELES
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State | CA
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Zip | 90026-4005
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Country | US
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Telephone | 213-302-2472
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. SIDNEY TODD MITCHELL
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Credential | MD
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Telephone | 831-588-2192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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