Healthcare Provider Details

I. General information

NPI: 1174140198
Provider Name (Legal Business Name): STEPHANIE N CARTER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 N FAIRFAX AVE APT 202
LOS ANGELES CA
90036-1784
US

IV. Provider business mailing address

639 N FAIRFAX AVE APT 202
LOS ANGELES CA
90036-1784
US

V. Phone/Fax

Practice location:
  • Phone: 610-462-9369
  • Fax:
Mailing address:
  • Phone: 610-462-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86104534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86104534
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86104534
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86104534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: