MEDICARE: DR. STEVEN TUDOR CHARLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C 28991	CA

General Provider Information

NPI Number	:	1225225998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN TUDOR CHARLES M.D.

Provider Business Mailing Address
First Line	:	1101 N SEPULVEDA BLVD
Second Line	:	SUITE 201
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5963
Country	:	US
Telephone Number	:	310-529-9307
Fax Number	:	626-572-2120

Provider Business Practice Location Address
First Line	:	2200 PACIFIC COAST HWY
Second Line	:	HSUITE 304A
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2702
Country	:	US
Telephone Number	:	310-529-9307
Fax Number	:	626-572-2120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	02/18/2022

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