Healthcare Provider Details

I. General information

NPI: 1962218446
Provider Name (Legal Business Name): CHARLES MICU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 ARTESIA BLVD UNIT 333
REDONDO BEACH CA
90278-6914
US

IV. Provider business mailing address

2750 ARTESIA BLVD UNIT 333
REDONDO BEACH CA
90278-6914
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-8765
  • Fax:
Mailing address:
  • Phone: 818-445-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number545868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: