Healthcare Provider Details

I. General information

NPI: 1841027208
Provider Name (Legal Business Name): NICOLE CHIARANON CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N EL CAMINO REAL STE A
OCEANSIDE CA
92058-1844
US

IV. Provider business mailing address

115 N EL CAMINO REAL STE A
OCEANSIDE CA
92058-1844
US

V. Phone/Fax

Practice location:
  • Phone: 760-330-5055
  • Fax: 760-542-2026
Mailing address:
  • Phone: 760-330-5055
  • Fax: 760-542-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: