Healthcare Provider Details

I. General information

NPI: 1689292633
Provider Name (Legal Business Name): RANDY M CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STEVENSON ST
SAN FRANCISCO CA
94103-1606
US

IV. Provider business mailing address

1282 MARKET ST
SAN FRANCISCO CA
94102-4801
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-2388
  • Fax:
Mailing address:
  • Phone: 415-360-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-OKRPUV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: