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NPI Code Detail

MEDICARE: DR. VICTORIA GUTIERREZ SMITH PH.D.

MEDICARE: DR. VICTORIA GUTIERREZ SMITH PH.D.
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
1103G00000XClinical NeuropsychologistPSY23616CA
2103TC0700XClinical PsychologistPSY23616CA
3103TH0004XHealth PsychologistPSY23616CA

General Provider Information

NPI Number : 1598070773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTORIA GUTIERREZ SMITH PH.D.
Provider Business Mailing Address
First Line : PO BOX 5626
Second Line :
City : FULLERTON
State : CA
Zip : 92838-0626
Country : US
Telephone Number : 714-615-1519
Fax Number :
Provider Business Practice Location Address
First Line : 1501 N HARBOR BLVD
Second Line : SUITE 211
City : FULLERTON
State : CA
Zip : 92835-3811
Country : US
Telephone Number : 714-615-1519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2010
Last Update Date : 08/12/2010

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