Provider Demographics
NPI:1194309237
Name:CHARLES, JEAN-ESDRACE GERMAIN (DR)
Entity type:Individual
Prefix:
First Name:JEAN-ESDRACE
Middle Name:GERMAIN
Last Name:CHARLES
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S GLENOAKS BLVD # 303
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1315
Mailing Address - Country:US
Mailing Address - Phone:818-209-8147
Mailing Address - Fax:
Practice Address - Street 1:7715 W SUNSET BLVD FRNT
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3912
Practice Address - Country:US
Practice Address - Phone:818-209-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000000