Provider Demographics
NPI:1528206240
Name:CADE, CHARLENE (AC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:CADE
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N BROADWAY STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1452
Mailing Address - Country:US
Mailing Address - Phone:323-226-0188
Mailing Address - Fax:
Practice Address - Street 1:1011 N BROADWAY STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1452
Practice Address - Country:US
Practice Address - Phone:323-226-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist