Individual
CHRISTOPHER J CHARBONNET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1530 E CHEVY CHASE DR, SUITE 204, GLENDALE, CA 91206-4163
(818) 241-7246
(818) 241-1639
Mailing address
PO BOX 5486, ORANGE, CA 92863-5486
(818) 550-0900
(505) 293-1524
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
G79131
CA
208VP0000X
Pain Medicine Physician
G79131
CA
208VP0014X
Interventional Pain Medicine Physician
Primary
G79131
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G791310
BLUE SHIELD
CA
05
—
00G791310
—
CA
Enumeration date
08/10/2006
Last updated
10/14/2021
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