Provider Information for 1578698379
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CHARLES ADAMS
Sex: Male
NPI: 1578698379
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1578698379 | ||||||||
| Enumeration Date | 2007-02-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 41661 LONG BEACH, CA 90853-1661 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 4025 W 226TH ST TORRANCE, CA 90505-2340 United States Phone: 310-373-4556 | Fax:310-373-4096 | ||||||||
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