Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DPM5283 | CA |
Y | 222Z00000X | Podiatrist | DPM5283 | CA |
NPI | 1003259664 |
---|---|
Provider Name | Ryan Carter |
First Address | Mountain View, CA 94040-6201 |
Second Address | Santa Monica, CA 90403-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2013 |
Last Update Date | 17/12/2021 |