Individual
CHARLES B. WORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3106 WEST BEVERLY BLVD, MONTEBELLO, CA 90640
(323) 726-3868
(323) 726-3870
Mailing address
3725 MIDVALE AVE #4, LOS ANGELES, CA 90034
(323) 726-3868
(323) 726-3870
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17689
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-4430908
TAX ID
CA
05
—
PA17689
—
CA
Enumeration date
06/27/2006
Last updated
12/08/2009
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