Provider Demographics
NPI:1184426751
Name:CHILCOTT, JAMES MATTHEW JR (RN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:CHILCOTT
Suffix:JR
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2101
Mailing Address - Country:US
Mailing Address - Phone:256-320-3716
Mailing Address - Fax:
Practice Address - Street 1:3075 HEALTH CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-637-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95114726163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology