Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NP 22808 | CA |
NPI | 1003158353 |
---|---|
Provider Name | Mrs. Angelique Babette Carter |
First Address | Rosemead, CA 91770-4394 |
Second Address | Norco, CA 92860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 27/11/2019 |