Healthcare Provider Details

I. General information

NPI: 1831231927
Provider Name (Legal Business Name): CHARLES L HERRING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 S SEPULVEDA BLVD STE 200
LOS ANGELES CA
90045-3624
US

IV. Provider business mailing address

PO BOX 9789
MARINA DEL REY CA
90295-2189
US

V. Phone/Fax

Practice location:
  • Phone: 310-641-8111
  • Fax: 310-337-7274
Mailing address:
  • Phone: 310-577-8500
  • Fax: 310-305-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG84865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG84865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: