Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO02283 | VA |
Y | 222Z00000X | Podiatrist | CPO02283 | VA |
N | 224P00000X | Prosthetist | CPO02283 | VA |
NPI | 1447585518 |
---|---|
Provider Name | Mr. Micah Carter |
First Address | Carson, CA 90746-2426 |
Second Address | Los Angeles, CA 90017-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 07/10/2009 |