Provider Demographics
NPI:1447585518
Name:CARTER, MICAH (CPO)
Entity Type:Individual
Prefix:MR
First Name:MICAH
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 TILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2426
Mailing Address - Country:US
Mailing Address - Phone:213-482-5226
Mailing Address - Fax:213-482-5040
Practice Address - Street 1:637 LUCAS AVE STE 609
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1912
Practice Address - Country:US
Practice Address - Phone:213-482-5226
Practice Address - Fax:213-482-5040
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO02283222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist