Basic Information
| Provider Information | |||||||||
| NPI: | 1053305979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARTHING | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 N MARTEL AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900466611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234365019 | ||||||||
| FaxNumber: | 3234365034 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 N LA CIENEGA BLVD | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106579353 | ||||||||
| FaxNumber: | 3106579367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | A52857 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 00A528570 | 05 | CA | MEDICAID |