Provider Demographics
NPI:1497126197
Name:CHELLIAH, SETH ESLY (MSN, PHN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ESLY
Last Name:CHELLIAH
Suffix:
Gender:M
Credentials:MSN, PHN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26470 ANTONIO CIR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6758
Mailing Address - Country:US
Mailing Address - Phone:909-809-2139
Mailing Address - Fax:
Practice Address - Street 1:461 TENNESSEE ST STE C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8161
Practice Address - Country:US
Practice Address - Phone:909-475-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95068057163W00000X
CA95012110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse