Provider Demographics
NPI:1770231300
Name:PRENTICE, CARTER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:MICHAEL
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARTER
Other - Middle Name:MICHAEL
Other - Last Name:GRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8358
Mailing Address - Country:US
Mailing Address - Phone:424-467-5487
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-5127
Practice Address - Country:US
Practice Address - Phone:310-794-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11507208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery