Healthcare Provider Details

I. General information

NPI: 1659646636
Provider Name (Legal Business Name): CHARLES E. IMBUS, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES EUGENE IMBUS
Title or Position: PHYSICIAN & PRESIDENT
Credential: MD
Phone: 626-445-6275