MEDICARE: CHARLES TOLBERT RPSGT

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1558611137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES TOLBERT RPSGT

Provider Business Mailing Address
First Line	:	PO BOX 6342
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95763-6342
Country	:	US
Telephone Number	:	916-337-5502
Fax Number	:

Provider Business Practice Location Address
First Line	:	983 RESERVE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-1340
Country	:	US
Telephone Number	:	916-337-5502
Fax Number	:	916-258-7277

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

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	01/12/2016

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