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General NPI Number Information
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NPI Number | 1225716590
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Entity Type | Individual
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Provider Name | MR. CHARLES CONNOR THORNTON
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Gender | Male
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 861 6TH AVE. SUITE 860
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City | SAN DIEGO
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State | CA
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Zip | 92101
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Country | US
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Telephone | 619-940-7577
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Fax | 619-923-5299
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Provider Business Mailing Address
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Address Line | 4680 LASER RD
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City | SHELBY
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State | OH
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Zip | 44875-9318
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Country | US
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Telephone | 419-566-4009
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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