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General NPI Number Information
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NPI Number | 1417839077
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Entity Type | Individual
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Provider Name | AUSTIN JEFFREY CHANDLER
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Gender | Male
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 03/08/2026
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Provider Practice Location Address
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Address Line | 18612 SANTA ANA AVE
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City | BLOOMINGTON
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State | CA
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Zip | 92316-2639
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Country | US
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Telephone | 951-990-6516
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Fax |
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Provider Business Mailing Address
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Address Line | 4390 ELMWOOD CT
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City | RIVERSIDE
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State | CA
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Zip | 92506-1138
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Country | US
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Telephone | 951-990-6516
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95026834
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95036803
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License Number State | CA
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