Healthcare Provider Details

I. General information

NPI: 1982928016
Provider Name (Legal Business Name): CAITLIN CHINN-GOSHGARIAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN CHINN PH.D.

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVENUE
CORCORAN CA
93212
US

IV. Provider business mailing address

PO BOX 6891
VISALIA CA
93290-6891
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY23393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: