Organization
CHRISTOPHER J. CHARBONNET, M.D., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER J CHARBONNET MD (PRESIDENT)
(818) 550-0900
Entity
Organization
Contact information
Practice address
1530 E CHEVY CHASE DR, STE 204, GLENDALE, CA 91206-4163
(818) 241-7246
(505) 293-1524
Mailing address
PO BOX 5486, ORANGE, CA 92863-5486
(818) 550-0900
(505) 293-1524
Taxonomy
Speciality
Code
Description
License number
State
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
05/03/2007
Last updated
04/23/2015
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