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General NPI Number Information
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NPI Number | 1427976836
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Entity Type | Organization
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Legal Business Name | CHARLIE ANDERSON LLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 7820 JELLICO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4337
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Country | US
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Telephone | 818-521-4292
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Fax |
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Provider Business Mailing Address
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Address Line | 7820 JELLICO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANCE ANDERSON
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Credential | MD
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Telephone | 818-521-4292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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