Provider Demographics
NPI:1457912768
Name:TRUSLOW, CHARLES ROMAINE (CADC,CAS-CA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROMAINE
Last Name:TRUSLOW
Suffix:
Gender:M
Credentials:CADC,CAS-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 LOCHABER CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8490
Mailing Address - Country:US
Mailing Address - Phone:951-965-6719
Mailing Address - Fax:
Practice Address - Street 1:23119 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9661
Practice Address - Country:US
Practice Address - Phone:951-782-5000
Practice Address - Fax:951-413-5230
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC034900615101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)