Provider Demographics
NPI:1174758502
Name:CHISHOLM, CAITLIN (MS)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MAGNOLIA AVENUE
Mailing Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3000
Mailing Address - Country:US
Mailing Address - Phone:951-353-3494
Mailing Address - Fax:951-353-5606
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3000
Practice Address - Country:US
Practice Address - Phone:951-353-3494
Practice Address - Fax:951-353-5606
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS