Healthcare Provider Details

I. General information

NPI: 1366364986
Provider Name (Legal Business Name): CHLOE GRACE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 EXECUTIVE DR
SAN DIEGO CA
92121-3074
US

IV. Provider business mailing address

4570 EXECUTIVE DR
SAN DIEGO CA
92121-3074
US

V. Phone/Fax

Practice location:
  • Phone: 844-838-3322
  • Fax:
Mailing address:
  • Phone: 844-838-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC002037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: