Provider Demographics
NPI:1649758962
Name:CHARLES, JOSEPH BERNARD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BERNARD
Last Name:CHARLES
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2400 MOORPARK AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2680
Mailing Address - Country:US
Mailing Address - Phone:415-827-9253
Mailing Address - Fax:
Practice Address - Street 1:5623 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3358
Practice Address - Country:US
Practice Address - Phone:818-991-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily