Healthcare Provider Details

I. General information

NPI: 1154466621
Provider Name (Legal Business Name): GERTRUDE SANDRA CARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE 2ND FLOOR
ORANGE CA
92868-4231
US

IV. Provider business mailing address

5366 VALLEY VIEW RD
RANCHO PALOS VERDES CA
90275-5089
US

V. Phone/Fax

Practice location:
  • Phone: 714-347-3261
  • Fax: 714-246-8648
Mailing address:
  • Phone: 310-872-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC37374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: