Healthcare Provider Details

I. General information

NPI: 1447882683
Provider Name (Legal Business Name): ALDRIN CHARLES SR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E BASELINE RD STE 101
TEMPE AZ
85283-1439
US

IV. Provider business mailing address

5416 E SOUTHERN AVE
MESA AZ
85206-3622
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-2301
  • Fax: 480-813-4534
Mailing address:
  • Phone: 480-632-2301
  • Fax: 480-813-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number598-PA
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8272
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: