# CHARLES R STEVENS, M.D., APC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHARLES R STEVENS, A PROFESSIONAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780967455
- **Legal business name:** CHARLES R STEVENS, A PROFESSIONAL CORPORATION
- **Authorized official:** CHARLES STEVENS M.D. (PRESIDENT)
- **Authorized official phone:** (760) 482-0212

## Contact information

- **Practice address:** 1665 S IMPERIAL AVE, SUITE D, EL CENTRO, CA 92243-4253
- **Practice address phone:** (760) 482-0212
- **Mailing address:** 1665 S IMPERIAL AVE STE D, EL CENTRO, CA 92243-4247
- **Mailing address phone:** (760) 482-0212
- **Mailing address fax:** (760) 482-0166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 09/20/2011
- **Last updated:** 02/22/2023