Healthcare Provider Details

I. General information

NPI: 1992091391
Provider Name (Legal Business Name): ANDREA RUTH CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44444 20TH ST W
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

44444 20TH ST W
LANCASTER CA
93534-2714
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA124095
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA124095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: