Healthcare Provider Details

I. General information

NPI: 1598450199
Provider Name (Legal Business Name): CHRISTINE N CHILESHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S GAFFEY ST
SAN PEDRO CA
90731-4628
US

IV. Provider business mailing address

1600 S GAFFEY ST
SAN PEDRO CA
90731-4628
US

V. Phone/Fax

Practice location:
  • Phone: 310-548-0201
  • Fax: 310-547-3340
Mailing address:
  • Phone: 617-682-6405
  • Fax: 310-547-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA203753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: