Provider Demographics
NPI:1346436243
Name:NEWCOMB, CHARLES W (RD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:35761 JOHN ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636
Mailing Address - Country:US
Mailing Address - Phone:559-645-6358
Mailing Address - Fax:888-224-0413
Practice Address - Street 1:35761 JOHN ALBERT DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-7924
Practice Address - Country:US
Practice Address - Phone:559-645-6358
Practice Address - Fax:888-224-0413
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24802ZMedicare PIN