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NPI Code Detail

MEDICARE: UNIQUE DIAMOND LANAY MITCHELL

MEDICARE: UNIQUE DIAMOND LANAY 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1316703812
Entity Type Code : Individual
Provider Name (Legal Business Name) : UNIQUE DIAMOND LANAY MITCHELL
Provider Business Mailing Address
First Line : 444 GEORGIA ST
Second Line :
City : VALLEJO
State : CA
Zip : 94590-6005
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1116 LEGEND CIR
Second Line :
City : VALLEJO
State : CA
Zip : 94591-8679
Country : US
Telephone Number : 707-647-3972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2024
Last Update Date : 11/01/2024

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Directions to “ UNIQUE DIAMOND LANAY MITCHELL ” Practice Location

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