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General NPI Number Information
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NPI Number | 1700296829
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Entity Type | Individual
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Provider Name | CHARLES VAINDER MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 1818 VERDUGO BLVD STE 304
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City | GLENDALE
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State | CA
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Zip | 91208-1444
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Country | US
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Telephone | 748-588-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 W BURBANK BLVD STE 1046
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City | BURBANK
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State | CA
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Zip | 91506-1315
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Country | US
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Telephone | 847-858-8588
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A168465
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License Number State | CA
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