Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A140912 | CA |
NPI | 1033539184 |
---|---|
Provider Name | Natasha Fewkes Carter |
First Address | San Diego, CA 92193-2410 |
Second Address | Portland, OR 97239-2883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 05/09/2018 |