MEDICARE: NOEMI ANA MITZEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	92004	CA

General Provider Information

NPI Number	:	1003442328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEMI ANA MITZEL LCSW

Provider Business Mailing Address
First Line	:	6977 NAVAJO RD # 654
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1503
Country	:	US
Telephone Number	:	619-382-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	6977 NAVAJO RD # 654
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1503
Country	:	US
Telephone Number	:	619-382-8662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	01/06/2025

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