Healthcare Provider Details

I. General information

NPI: 1396740072
Provider Name (Legal Business Name): JOHN ANGUS CHISHOLM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 F ST STE 100
CHULA VISTA CA
91910-2632
US

IV. Provider business mailing address

345 F ST STE 100
CHULA VISTA CA
91910-2632
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3481
  • Fax: 619-420-7807
Mailing address:
  • Phone: 619-427-3481
  • Fax: 619-420-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: