Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12240 VENICE BLVD STE 30
LOS ANGELES CA
90066-3891
US

IV. Provider business mailing address

5319 UNIVERSITY DR UNIT 10100
IRVINE CA
92612-2965
US

V. Phone/Fax

Practice location:
  • Phone: 949-996-0981
  • Fax: 855-710-6676
Mailing address:
  • Phone: 949-996-0981
  • Fax: 855-710-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE CARTER
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 949-996-0981