Provider Demographics
NPI:1891847976
Name:GLEESON, CHARLES E (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:GLEESON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:11770 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 370
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2422
Practice Address - Country:US
Practice Address - Phone:858-673-3360
Practice Address - Fax:619-528-4625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16543363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health