Provider Demographics
NPI:1558611137
Name:TOLBERT, CHARLES (RPSGT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6342
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-6342
Mailing Address - Country:US
Mailing Address - Phone:916-337-5502
Mailing Address - Fax:
Practice Address - Street 1:983 RESERVE DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1340
Practice Address - Country:US
Practice Address - Phone:916-337-5502
Practice Address - Fax:916-258-7277
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other