Healthcare Provider Details

I. General information

NPI: 1558122127
Provider Name (Legal Business Name): SIOBHAN P CARTER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 ARRIFANA LN
EASTVALE CA
91752-7303
US

IV. Provider business mailing address

6275 ARRIFANA LN
EASTVALE CA
91752-7303
US

V. Phone/Fax

Practice location:
  • Phone: 310-749-2540
  • Fax:
Mailing address:
  • Phone: 310-749-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code364SP0811X
TaxonomyChronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number4842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: