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General NPI Number Information
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NPI Number | 1497126197
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Entity Type | Individual
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Provider Name | SETH ESLY CHELLIAH MSN, PHN, RN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 461 TENNESSEE ST STE C
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City | REDLANDS
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State | CA
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Zip | 92373-8161
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Country | US
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Telephone | 909-475-7571
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Fax |
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Provider Business Mailing Address
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Address Line | 26470 ANTONIO CIR
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City | LOMA LINDA
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State | CA
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Zip | 92354-6758
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Country | US
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Telephone | 909-809-2139
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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 | 95068057
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95012110
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License Number State | CA
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