Healthcare Provider Details

I. General information

NPI: 1851067417
Provider Name (Legal Business Name): DR. CHARLES WILLIAM DURNIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 LIDO LANE
LONG BEACH CA
90803
US

IV. Provider business mailing address

6010 LIDO LANE
LONG BEACH CA
90803
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-4695
  • Fax:
Mailing address:
  • Phone: 562-439-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberC30614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: