Provider Demographics
NPI:1093094245
Name:CARTER-ALEXANDER, EMMA RUTH
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:RUTH
Last Name:CARTER-ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EMMA
Other - Middle Name:RUTH
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3081 TEAGARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5720
Mailing Address - Country:US
Mailing Address - Phone:510-347-4620
Mailing Address - Fax:510-483-4486
Practice Address - Street 1:3081 TEAGARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5720
Practice Address - Country:US
Practice Address - Phone:510-347-4620
Practice Address - Fax:510-483-4486
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program