Healthcare Provider Details

I. General information

NPI: 1306662267
Provider Name (Legal Business Name): WARREN ROLAND CARTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S MAIN ST STE 209
CORONA CA
92882-3401
US

IV. Provider business mailing address

9363 NARNIA DR
RIVERSIDE CA
92503-5634
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax:
Mailing address:
  • Phone: 951-292-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA65960
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: