Charles Henderson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA63215 Issued in CA

Practice address

1230 E Arrow Hwy
Upland, CA 91786-4910

Phone

(626) 807-8545

NPI assigned

Sep 21, 2023

Last updated

Jan 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aastha, Inc

  • Primary Care Clinic/Center
  • Pomona, CA
  • NPI 1700171105
  NPD (past)
• Coastal Kids, a Professional Medical Corporation

  dba Coastal Kids

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1740311737
  NPD (past)

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1700665536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 E ALTADENA DR",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "910012240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E ARROW HWY",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864910",
            "telephone_number": "626-807-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-21",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA63215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Heidari, D.O.
• Chelsea Heller, MS, MS, PPS, LMFT
• Helpful Hand Assisted Living LLC
• Helping Hands Hospice Care, Inc.
• Martha Henao, MD
• Henley Optometric Corporation (Upland Eye Care)
• Jason Henley
• Jon Michael Henley, O.D.
• Milagros Lizeth Henriquez
• Henry J Gonzalez M D Inc

• Medical Physician Assistant in Upland, CA
• Providers in Upland, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.