Provider Demographics
NPI:1730759655
Name:MITCHELL, BEVERLY A
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 S 7TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2418
Mailing Address - Country:US
Mailing Address - Phone:562-546-2458
Mailing Address - Fax:
Practice Address - Street 1:8604 S 7TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2418
Practice Address - Country:US
Practice Address - Phone:562-546-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist