Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT22644 | CA |
NPI | 1972532661 |
---|---|
Provider Name | Charles J Mclaughlin |
First Address | Fullerton, CA 92831-2743 |
Second Address | Anaheim, CA 92802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 24/08/2018 |