Healthcare Provider Details

I. General information

NPI: 1174758502
Provider Name (Legal Business Name): CAITLIN CHISHOLM M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
RIVERSIDE CA
92505-3000
US

IV. Provider business mailing address

10800 MAGNOLIA AVENUE SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
RIVERSIDE CA
92505-3000
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-3494
  • Fax: 951-353-5606
Mailing address:
  • Phone: 951-353-3494
  • Fax: 951-353-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: