Provider Demographics
NPI:1922192046
Name:SKIBA JR, CHARLES ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:SKIBA JR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462051
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-8051
Mailing Address - Country:US
Mailing Address - Phone:323-939-1603
Mailing Address - Fax:323-939-1643
Practice Address - Street 1:9229 WILSHIRE BLVD # 1
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5501
Practice Address - Country:US
Practice Address - Phone:323-939-1603
Practice Address - Fax:323-939-1643
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9707208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice