Provider Demographics
NPI:1619606753
Name:CARTER, BRIAN II
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CARTER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 E COMMERCE WAY UNIT 8101
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-3009
Mailing Address - Country:US
Mailing Address - Phone:916-262-5736
Mailing Address - Fax:
Practice Address - Street 1:5301 E COMMERCE WAY UNIT 8101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-3009
Practice Address - Country:US
Practice Address - Phone:916-262-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6760023172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver