Provider Demographics
NPI:1023673118
Name:CARTER, TRANEEHA LA'STARR
Entity type:Individual
Prefix:
First Name:TRANEEHA
Middle Name:LA'STARR
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 B ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4237
Mailing Address - Country:US
Mailing Address - Phone:510-247-9115
Mailing Address - Fax:
Practice Address - Street 1:1122 B ST STE 101
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4237
Practice Address - Country:US
Practice Address - Phone:510-247-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK5672831744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management