Healthcare Provider Details

I. General information

NPI: 1619749314
Provider Name (Legal Business Name): CORINNE CHILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 COFFEE RD
MODESTO CA
95355-1731
US

IV. Provider business mailing address

3015 COFFEE RD
MODESTO CA
95355-1731
US

V. Phone/Fax

Practice location:
  • Phone: 559-690-0650
  • Fax:
Mailing address:
  • Phone: 559-690-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: