Individual provider Active NPI

Charles Edward Gunnoe Jr., BA

  • Rehabilitation Practitioner
  • San Bernardino, CA
National Provider Identifier
1174666754
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
Practice address
658 E Brier Dr
Suite 250
San Bernardino, CA 92415-0036
Phone
(909) 893-0672
Fax
(909) 501-0831
NPI assigned
Feb 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X Primary

Addresses

Primary practice location

658 E Brier Dr
Suite 250
San Bernardino, CA 92415-0036

Mailing address

1551 Webster St
Redlands, CA 92374
Phone (909) 380-4646

Other names 1

  • Mr. C Edward (Ed) Gunnoe Jr. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Arts

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1174666754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 WEBSTER ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92374",
            "telephone_number": "909-380-4646",
            "fax_number": "909-894-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "658 E BRIER DR",
            "address_2": "SUITE 250",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150036",
            "telephone_number": "909-893-0672",
            "fax_number": "909-501-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNNOE",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C",
            "last_name": "GUNNOE",
            "middle_name": "EDWARD (ED)",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "BA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.