Healthcare Provider Details

I. General information

NPI: 1518425347
Provider Name (Legal Business Name): MS. EULA B CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 N WATERMAN AVE STE 1
SAN BERNARDINO CA
92404-5131
US

IV. Provider business mailing address

1738 N WATERMAN AVE STE 1
SAN BERNARDINO CA
92404-5131
US

V. Phone/Fax

Practice location:
  • Phone: 909-693-3302
  • Fax: 909-474-9610
Mailing address:
  • Phone: 909-693-3302
  • Fax: 909-474-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: