MEDICARE: CHARLES E. IMBUS, MD, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician
4	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1912999764	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1659646636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES E. IMBUS, MD, INC

Provider Business Mailing Address
First Line	:	665 W NAOMI AVE STE 202
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 W NAOMI AVE STE 202
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:	626-445-6275
Fax Number	:	626-445-3583

Authorized Official
Title or Position	:	PHYSICIAN & PRESIDENT
Name	:	DR. CHARLES EUGENE IMBUS
Credential	:	MD
Telephone Number	:	626-445-6275

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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Directions to “CHARLES E. IMBUS, MD, INC ” Practice Location

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