Basic Information
Provider Information | |||||||||
NPI: | 1134130230 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CARTER | ||||||||
FirstName: | JANICE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. M.P.H. F.A.A.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CARTER-LOURENSZ MD | ||||||||
OtherFirstName: | JANICE | ||||||||
OtherMiddleName: | H | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D., M.P.H, F.A.A.P | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 3136 STANFORD AVE | ||||||||
Address2: |   | ||||||||
City: | MARINA DEL REY | ||||||||
State: | CA | ||||||||
PostalCode: | 902925529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108259989 | ||||||||
FaxNumber: | 3108213280 | ||||||||
Practice Location | |||||||||
Address1: | 3136 STANFORD AVE | ||||||||
Address2: |   | ||||||||
City: | MARINA DEL REY | ||||||||
State: | CA | ||||||||
PostalCode: | 902925529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108259989 | ||||||||
FaxNumber: | 3108213280 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2006 | ||||||||
LastUpdateDate: | 11/18/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G38033 | CA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2080P0006X | G38033 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
ID Information
ID | Type | State | Issuer | Description | OOG380330 | 01 | CA | MEDICAL | OTHER |