Provider Demographics
NPI:1790836500
Name:PICKETT, ANTHONY CARL (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CARL
Last Name:PICKETT
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2640
Mailing Address - Country:US
Mailing Address - Phone:323-846-7200
Mailing Address - Fax:323-846-7206
Practice Address - Street 1:5859 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3741
Practice Address - Country:US
Practice Address - Phone:323-753-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076921207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G769212Medicaid
CA00G769210Medicaid