Healthcare Provider Details

I. General information

NPI: 1053305979
Provider Name (Legal Business Name): CHARLES FRANK FARTHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD SUITE #200
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

1001 N MARTEL AVE
WEST HOLLYWOOD CA
90046-6611
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-9353
  • Fax: 310-657-9367
Mailing address:
  • Phone: 323-436-5019
  • Fax: 323-436-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA52857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: