Healthcare Provider Details

I. General information

NPI: 1619799368
Provider Name (Legal Business Name): CHARLES ANCHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RANCHO CAMINO DR
POMONA CA
91766-7030
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE SUITE 220
MONROVIA CA
91016-4066
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-0974
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 888-588-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: