Provider Demographics
NPI:1538251681
Name:MITRA, SANCHAYEETA (MD)
Entity type:Individual
Prefix:
First Name:SANCHAYEETA
Middle Name:
Last Name:MITRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291815
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-8815
Mailing Address - Country:US
Mailing Address - Phone:203-589-8555
Mailing Address - Fax:
Practice Address - Street 1:12462 PUTNAM ST STE 500
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1049
Practice Address - Country:US
Practice Address - Phone:203-589-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53751207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology