MEDICARE: MS. DIANI SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1316166077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANI SMITH

Provider Business Mailing Address
First Line	:	855 VICTOR AVE
Second Line	:	APT. #108
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2640
Country	:	US
Telephone Number	:	310-400-4339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 S. CENTRAL AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011
Country	:	US
Telephone Number	:	213-493-4664
Fax Number	:	213-537-0110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	11/14/2013

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