1013569912 NPI number — MISS CAROLINE ELIZABETH GILCHRIST

Table of content: MISS CAROLINE ELIZABETH GILCHRIST (NPI 1013569912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013569912 NPI number — MISS CAROLINE ELIZABETH GILCHRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILCHRIST
Provider First Name:
CAROLINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMOUREUX
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013569912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1277 MONTEGO APT 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-818-8721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 N WIGET LN STE 275
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-285-5331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  133074 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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