Healthcare Provider Details

I. General information

NPI: 1124078894
Provider Name (Legal Business Name): CHERRIE R CHILOM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FROST ST KNOLLWOOD BUILDING, # 76
SAN DIEGO CA
92123-2701
US

IV. Provider business mailing address

7901 FROST ST KNOLLWOOD BUILDING, # 76
SAN DIEGO CA
92123-2701
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-4747
  • Fax:
Mailing address:
  • Phone: 858-300-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN180161
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN544717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: