Healthcare Provider Details

I. General information

NPI: 1730360140
Provider Name (Legal Business Name): CHARLES T RESNICK, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE SUITE 250
PASADENA CA
91105-2613
US

IV. Provider business mailing address

625 S FAIR OAKS AVE SUITE 250
PASADENA CA
91105-2613
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-6426
  • Fax: 626-795-6422
Mailing address:
  • Phone: 626-795-6426
  • Fax: 626-795-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG37039
License Number StateCA

VIII. Authorized Official

Name: SANDRA RESNICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-795-6426