Provider Demographics
NPI:1437440625
Name:CHAROEN, CHARINDA (PA)
Entity Type:Individual
Prefix:
First Name:CHARINDA
Middle Name:
Last Name:CHAROEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2446
Mailing Address - Country:US
Mailing Address - Phone:909-925-5567
Mailing Address - Fax:909-621-4900
Practice Address - Street 1:9301 CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2446
Practice Address - Country:US
Practice Address - Phone:909-925-5567
Practice Address - Fax:909-621-4900
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical