Healthcare Provider Details

I. General information

NPI: 1912999764
Provider Name (Legal Business Name): CHARLES E. IMBUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 W NAOMI AVE SUITE 202
ARCADIA CA
91007-7563
US

IV. Provider business mailing address

665 W NAOMI AVE SUITE 202
ARCADIA CA
91007-7563
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-6275
  • Fax: 626-445-3583
Mailing address:
  • Phone: 626-445-6275
  • Fax: 626-445-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC34642
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC34642
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC34642
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberC34642
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC34642
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberC34642
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberC34642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: