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General NPI Number Information
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NPI Number | 1174666754
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Entity Type | Individual
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Provider Name | CHARLES EDWARD GUNNOE JR. BA
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 658 E BRIER DR SUITE 250
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0036
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Country | US
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Telephone | 909-893-0672
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Fax | 909-501-0831
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Provider Business Mailing Address
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Address Line | 1551 WEBSTER ST
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-380-4646
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Fax | 909-894-3160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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