Healthcare Provider Details

I. General information

NPI: 1174541239
Provider Name (Legal Business Name): RENE CHARLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N VERMONT AVE
DINUBA CA
93618-1631
US

IV. Provider business mailing address

342 N VERMONT AVE
DINUBA CA
93618-1631
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-7229
  • Fax: 559-783-2084
Mailing address:
  • Phone: 559-591-7229
  • Fax: 559-783-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG71775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: