Provider Demographics
NPI:1912999764
Name:IMBUS, CHARLES E (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:IMBUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W NAOMI AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7563
Mailing Address - Country:US
Mailing Address - Phone:626-445-6275
Mailing Address - Fax:626-445-3583
Practice Address - Street 1:665 W NAOMI AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7563
Practice Address - Country:US
Practice Address - Phone:626-445-6275
Practice Address - Fax:626-445-3583
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34642174400000X, 2084N0400X, 2084N0402X, 2084S0012X, 2081N0008X, 202C00000X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C346420Medicaid
756131315OtherMEDICARE - RR PTAN
C34642Medicare ID - Type Unspecified
CA00C346420Medicaid