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NPI Code Detail

MEDICARE: DAWN SMITH

MEDICARE: DAWN 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
1106H00000XMarriage & Family TherapistIMF 65920CA

General Provider Information

NPI Number : 1447535802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN SMITH
Provider Business Mailing Address
First Line : 4506 VALDINA PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-2707
Country : US
Telephone Number : 310-703-7517
Fax Number :
Provider Business Practice Location Address
First Line : 1030 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-2442
Country : US
Telephone Number : 310-703-7517
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 10/18/2011

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