Healthcare Provider Details

I. General information

NPI: 1033301718
Provider Name (Legal Business Name): CHARLES D. SHORT JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HOPYARD RD SUITE 100
PLEASANTON CA
94588-3348
US

IV. Provider business mailing address

5000 HOPYARD RD SUITE 100
PLEASANTON CA
94588-3348
US

V. Phone/Fax

Practice location:
  • Phone: 925-924-1600
  • Fax:
Mailing address:
  • Phone: 925-924-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number647464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: