Healthcare Provider Details

I. General information

NPI: 1104369313
Provider Name (Legal Business Name): ALTA MARIE CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVENUE
RIVERSIDE CA
92504
US

IV. Provider business mailing address

39249 LEOPARD ST
PALM DESERT CA
92211-1146
US

V. Phone/Fax

Practice location:
  • Phone: 951-742-6380
  • Fax:
Mailing address:
  • Phone: 909-206-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1104369313
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: