Individual
MR. ALPHONSO CHISLOM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.C.P.
Contact information
Practice address
5880 FAIR ISLE DR APT 283, RIVERSIDE, CA 92507-8462
(951) 378-2083
(951) 786-7726
Mailing address
5880 FAIR ISLE DR APT 283, RIVERSIDE, CA 92507-8462
(951) 378-2083
(951) 786-7726
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
00017933
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00017933
CA. STATE LICENSE
CA
Enumeration date
05/08/2008
Last updated
05/08/2008
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