Provider Demographics
NPI:1780967455
Name:CHARLES R STEVENS, M.D., APC
Entity type:Organization
Organization Name:CHARLES R STEVENS, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-482-0212
Mailing Address - Street 1:1665 S IMPERIAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4247
Mailing Address - Country:US
Mailing Address - Phone:760-482-0212
Mailing Address - Fax:760-482-0166
Practice Address - Street 1:1665 S IMPERIAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4253
Practice Address - Country:US
Practice Address - Phone:760-482-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES R STEVENS, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site