MEDICARE: GABRIELLE CARTER, PMHNP-BC, PSYCHIATRIC NURSING PRACTITIONER, PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1457203903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIELLE CARTER, PMHNP-BC, PSYCHIATRIC NURSING PRACTITIONER, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5319 UNIVERSITY DR UNIT 10100
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2965
Country	:	US
Telephone Number	:	949-996-0981
Fax Number	:	855-710-6676

Provider Business Practice Location Address
First Line	:	12240 VENICE BLVD STE 30
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3891
Country	:	US
Telephone Number	:	949-996-0981
Fax Number	:	855-710-6676

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GABRIELLE CARTER
Credential	:	PMHNP-BC
Telephone Number	:	949-996-0981

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	05/27/2026

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