Provider Demographics
NPI:1124198536
Name:CHARLES, MISLYNNE ANITA (MD)
Entity type:Individual
Prefix:
First Name:MISLYNNE
Middle Name:ANITA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1509 WILSON TER
Mailing Address - Street 2:REHABILITATION INSTITUTE
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4007
Mailing Address - Country:US
Mailing Address - Phone:818-409-8088
Mailing Address - Fax:818-546-5609
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:REHABILITATION INSTITUTE
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8088
Practice Address - Fax:818-546-5609
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56004208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation