Provider Demographics
NPI:1134130230
Name:CARTER, JANICE (MD MPH FAAP)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD MPH FAAP
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:H
Other - Last Name:CARTER-LOURENSZ MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH, FAAP
Mailing Address - Street 1:3136 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5529
Mailing Address - Country:US
Mailing Address - Phone:310-825-9989
Mailing Address - Fax:310-821-3280
Practice Address - Street 1:3136 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5529
Practice Address - Country:US
Practice Address - Phone:310-825-9989
Practice Address - Fax:310-821-3280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG380332084P0800X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG380330OtherMEDICAL
CAA91959Medicare UPIN
CAWG38033AMedicare ID - Type Unspecified