Provider Demographics
NPI:1760540991
Name:STONE, CHARLES FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:STONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:67 VIA SONRISA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5691
Mailing Address - Country:US
Mailing Address - Phone:949-278-2395
Mailing Address - Fax:888-742-7014
Practice Address - Street 1:6833 INDIANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4223
Practice Address - Country:US
Practice Address - Phone:657-346-6319
Practice Address - Fax:951-269-4184
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A79972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1512013461Medicaid
CA1512013461Medicaid
CA1512013461Medicare UPIN