Provider Demographics
NPI:1710210307
Name:HYMAN, CHARLES JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOEL
Last Name:HYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 BROOKSIDE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5181
Mailing Address - Country:US
Mailing Address - Phone:909-748-5045
Mailing Address - Fax:909-792-2919
Practice Address - Street 1:710 BROOKSIDE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5181
Practice Address - Country:US
Practice Address - Phone:909-748-5045
Practice Address - Fax:909-792-2919
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG21691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261818067OtherEIN