MEDICARE: DR. CHARLES E. IMBUS MD

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	174400000X	Specialist	C34642	CA
2	2084N0400X	Neurology Physician	C34642	CA
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	C34642	CA
4	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	C34642	CA
5	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	C34642	CA
6	202C00000X	Independent Medical Examiner Physician	C34642	CA
7	2080S0012X	Pediatric Sleep Medicine Physician	C34642	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	756131315	OTHER		MEDICARE - RR PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912999764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E. IMBUS MD

Provider Business Mailing Address
First Line	:	665 W NAOMI AVE
Second Line	:	SUITE 202
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:	626-445-6275
Fax Number	:	626-445-3583

Provider Business Practice Location Address
First Line	:	665 W NAOMI AVE
Second Line	:	SUITE 202
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:	626-445-6275
Fax Number	:	626-445-3583

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	04/30/2009

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Directions to “ DR. CHARLES E. IMBUS MD” Practice Location

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