Healthcare Provider Details

I. General information

NPI: 1073316824
Provider Name (Legal Business Name): JANE F SMITH PPS SCHOOL COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 TAVERN RD
ALPINE CA
91901-3134
US

IV. Provider business mailing address

2001 TAVERN RD
ALPINE CA
91901-3129
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-8676
  • Fax: 619-445-1420
Mailing address:
  • Phone: 619-445-8676
  • Fax: 619-445-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: