Provider Demographics
NPI:1154466621
Name:CARTER, GERTRUDE SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:GERTRUDE
Middle Name:SANDRA
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5089
Mailing Address - Country:US
Mailing Address - Phone:310-872-7287
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:714-347-3261
Practice Address - Fax:714-246-8648
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics