Provider Demographics
NPI:1316360969
Name:V. CHARLES CHARUVASTRA, MD, INC
Entity type:Organization
Organization Name:V. CHARLES CHARUVASTRA, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:V
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CHARUVASTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-904-8905
Mailing Address - Street 1:PO BOX 33317
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0317
Mailing Address - Country:US
Mailing Address - Phone:562-904-8905
Mailing Address - Fax:
Practice Address - Street 1:8301 FLORENCE AVE STE 304
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240
Practice Address - Country:US
Practice Address - Phone:562-904-8905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA297842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29784Medicare PIN