Healthcare Provider Details

I. General information

NPI: 1376486787
Provider Name (Legal Business Name): BRIAN CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 VISTA TER
PALM SPRINGS CA
92262-0133
US

IV. Provider business mailing address

230 VISTA TER
PALM SPRINGS CA
92262-0133
US

V. Phone/Fax

Practice location:
  • Phone: 415-400-6999
  • Fax:
Mailing address:
  • Phone: 415-400-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: