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General NPI Number Information
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NPI Number | 1366767485
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Entity Type | Individual
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Provider Name | CARRIE CHANSON M.D., DR.PH, MPM
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Gender | Female
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 328 COMMERCIAL RD STE 101 LOMA LINDA OCCUPATIONAL MEDICINE CLINIC
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3766
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Country | US
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Telephone | 909-558-6662
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Fax |
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Provider Business Mailing Address
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Address Line | 328 COMMERCIAL RD STE 101 LOMA LINDA OCCUPATIONAL MEDICINE CLINIC
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3766
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Country | US
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Telephone | 909-558-6662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | A122043
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License Number State | CA
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