Healthcare Provider Details

I. General information

NPI: 1578582185
Provider Name (Legal Business Name): CHARLES E XUEREB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 EL MONTE AVE SUITE A
MOUNTAIN VIEW CA
94040-2336
US

IV. Provider business mailing address

177 BOVET RD FL 6 ATTN: CD BILLING
SAN MATEO CA
94402-3116
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-9008
  • Fax:
Mailing address:
  • Phone: 701-255-9279
  • Fax: 701-222-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG46146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: