Healthcare Provider Details

I. General information

NPI: 1235940727
Provider Name (Legal Business Name): JORDAN CHILLINSKY LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 FILAREE CT
CARLSBAD CA
92011-5020
US

IV. Provider business mailing address

9756 MIKETO WAY
ELK GROVE CA
95757-6247
US

V. Phone/Fax

Practice location:
  • Phone: 760-889-3698
  • Fax:
Mailing address:
  • Phone: 415-967-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: