Healthcare Provider Details

I. General information

NPI: 1881199909
Provider Name (Legal Business Name): CHRISTOPHER ANTHONY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHOREWAY RD STE 100
BELMONT CA
94002-4110
US

IV. Provider business mailing address

3400 DATA DR CREDENTIALING AND PAYER ENROLLMENT
RANCHO CORDOVA CA
95670
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-7000
  • Fax: 650-596-7093
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA179342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: