Healthcare Provider Details

I. General information

NPI: 1366478539
Provider Name (Legal Business Name): DR. CHARLES JOSEPH KONYA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18520 SOLEDAD CANYON RD SUITE F
CANYON COUNTRY CA
91351-3775
US

IV. Provider business mailing address

24607 GARLAND DR
VALENCIA CA
91355-4962
US

V. Phone/Fax

Practice location:
  • Phone: 661-298-9500
  • Fax: 661-250-0323
Mailing address:
  • Phone: 661-253-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: