Individual
TEODORO LAURO CARACHURE CHARCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3030 W OLYMPIC BLVD STE 217, LOS ANGELES, CA 90006-6507
(213) 550-2159
Mailing address
1722 MITCHELL AVE APT 91, TUSTIN, CA 92780-6363
(714) 409-7718
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95029381
CA
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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