MEDICARE: DR. ALDRIN CHARLES SR. PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	8272	AZ
2	363A00000X	Physician Assistant	598-PA	PR

General Provider Information

NPI Number	:	1447882683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALDRIN CHARLES SR. PA

Provider Business Mailing Address
First Line	:	5416 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3622
Country	:	US
Telephone Number	:	480-632-2301
Fax Number	:	480-813-4534

Provider Business Practice Location Address
First Line	:	1250 E BASELINE RD STE 101
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1439
Country	:	US
Telephone Number	:	480-632-2301
Fax Number	:	480-813-4534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	01/26/2024

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Directions to “ DR. ALDRIN CHARLES SR. PA” Practice Location

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