Healthcare Provider Details

I. General information

NPI: 1265613715
Provider Name (Legal Business Name): MRS. VIRGINIA CARBAJAL CHALMERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WASHINGTON AVE STE 100
ESCONDIDO CA
92025-1806
US

IV. Provider business mailing address

447 N EL MOLINO AVE
PASADENA CA
91101-1403
US

V. Phone/Fax

Practice location:
  • Phone: 760-737-8642
  • Fax: 760-737-8918
Mailing address:
  • Phone: 626-577-8480
  • Fax: 626-577-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: