Doctor Name: | SROBONA MITRA |
NPI Number: | 1770601353 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | ML20007916 |
Business Practice Address: | 1806 W Lincoln Ave Yakima, WA - 989022473 |
Business Phone Number: | 5094524520 |
Business Fax Number: | 5094525224 |
Mailing Address: | 18625 Ne 139th St, WOODINVILLE |
State: | WA |
Postal Code: | 980726586 |
Phone Number: | 2068497273 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 03/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | ML20007916 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |