Healthcare Provider Details

I. General information

NPI: 1427184761
Provider Name (Legal Business Name): CHARLES H HERBSTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRESNO & R STREET
FRESNO CA
93721-1365
US

IV. Provider business mailing address

PO BOX 3645
TORRANCE CA
90510-3645
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-6000
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG54673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: