Provider Demographics
NPI:1720303860
Name:KREUSER, CHARLES (CST ASC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:KREUSER
Suffix:
Gender:M
Credentials:CST ASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 N LAUREL AVE
Mailing Address - Street 2:#3
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5144
Mailing Address - Country:US
Mailing Address - Phone:323-654-2792
Mailing Address - Fax:
Practice Address - Street 1:1245 N LAUREL AVE
Practice Address - Street 2:#3
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5144
Practice Address - Country:US
Practice Address - Phone:323-654-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32364246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist