Healthcare Provider Details

I. General information

NPI: 1033186747
Provider Name (Legal Business Name): CHARLES A NEUMANN X DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 BALRA DR
EL CERRITO CA
94530-3302
US

IV. Provider business mailing address

781 BALRA DR
EL CERRITO CA
94530-3302
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-7705
  • Fax:
Mailing address:
  • Phone: 510-525-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-053128
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A4150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: