| Doctor Name: | DR. CHARLES DELOSS PICKETT |
| NPI Number: | 1518398007 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 20A 4412 |
| Business Practice Address: | 812 Corral Ct Bonita, CA - 919022313 |
| Business Phone Number: | 6194799732 |
| Business Fax Number: | 6194795259 |
| Mailing Address: | 812 Corral Ct, BONITA |
| State: | CA |
| Postal Code: | 919022313 |
| Phone Number: | 6194799732 |
| Fax Number: | 6194795259 |
| NPI Enumeration Date: | 12/09/2013 |
| NPI Last Update Date: | 12/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 20A 4412 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |