MEDICARE: PRIYA MITRA MD

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	2085R0001X	Radiation Oncology Physician	C169366	CA

General Provider Information

NPI Number	:	1174721617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYA MITRA MD

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 EASTLAKE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-3018
Country	:	US
Telephone Number	:	323-865-3050
Fax Number	:

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	11/03/2025

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