MEDICARE: MR. MITCHELL RAY RICE NP

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	363L00000X	Nurse Practitioner	275200	CA
2	363LA2200X	Adult Health Nurse Practitioner	275299	CA
3	363LP2300X	Primary Care Nurse Practitioner	275200	CA

General Provider Information

NPI Number	:	1417056987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL RAY RICE NP

Provider Business Mailing Address
First Line	:	4060 MT. EVEREST BLD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111
Country	:	US
Telephone Number	:	858-576-6315
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 MOUNT EVEREST BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2625
Country	:	US
Telephone Number	:	858-576-6315
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/11/2025

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