Healthcare Provider Details

I. General information

NPI: 1366443533
Provider Name (Legal Business Name): CHARLES KERBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

4444 TOPA TOPA DR
LA MESA CA
91941-7160
US

IV. Provider business mailing address

4444 TOPA TOPA DR
LA MESA CA
91941-7160
US

V. Phone/Fax

Practice location:
  • Phone: 760-598-8058
  • Fax: 760-598-8078
Mailing address:
  • Phone: 760-598-8058
  • Fax: 760-598-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberC30735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC30735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: