Individual
CHANNEL DEVON CHISLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4193 FLAT ROCK DR, RIVERSIDE, CA 92505-7111
(747) 202-9158
Mailing address
4193 FLAT ROCK DR, RIVERSIDE, CA 92505-7111
(747) 202-9158
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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