MEDICARE: ERIC CHRISTOPHER MITCHELL

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083936165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHRISTOPHER MITCHELL

Provider Business Mailing Address
First Line	:	6102 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1428
Country	:	US
Telephone Number	:	661-236-7765
Fax Number	:	661-722-6390

Provider Business Practice Location Address
First Line	:	6102 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1428
Country	:	US
Telephone Number	:	661-236-7765
Fax Number	:	661-722-6390

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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