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NPI Code Detail

MEDICARE: JANESA SMITH

MEDICARE:   JANESA  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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1396636130
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANESA SMITH
Provider Business Mailing Address
First Line : 10106 MALLISON AVE
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6142
Country : US
Telephone Number : 213-925-8722
Fax Number :
Provider Business Practice Location Address
First Line : 233 S QUINTANA DR
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-4029
Country : US
Telephone Number : 510-317-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2025
Last Update Date : 12/09/2025

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Directions to “ JANESA SMITH ” Practice Location

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