Provider Demographics
NPI:1174666754
Name:GUNNOE, CHARLES EDWARD JR (BA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:GUNNOE
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:C
Other - Middle Name:EDWARD (ED)
Other - Last Name:GUNNOE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1551 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:909-380-4646
Mailing Address - Fax:909-894-3160
Practice Address - Street 1:658 E BRIER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0036
Practice Address - Country:US
Practice Address - Phone:909-893-0672
Practice Address - Fax:909-501-0831
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner