Provider Demographics
NPI:1316787690
Name:MCILWAIN, CHRISTIAN RANDALL
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:RANDALL
Last Name:MCILWAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26562 ESPALTER DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5116
Mailing Address - Country:US
Mailing Address - Phone:714-318-9189
Mailing Address - Fax:
Practice Address - Street 1:26562 ESPALTER DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5116
Practice Address - Country:US
Practice Address - Phone:714-318-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577271163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant