Provider Demographics
NPI:1568154086
Name:CHALMERS, JACLYN CATHLEEN
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:CATHLEEN
Last Name:CHALMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 WEYBURN DR APT 534
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2832
Mailing Address - Country:US
Mailing Address - Phone:707-256-9652
Mailing Address - Fax:
Practice Address - Street 1:10833 LECONTE AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:323-285-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program