Healthcare Provider Details

I. General information

NPI: 1366389736
Provider Name (Legal Business Name): PATRICIA ANNE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7668 EL CAMINO REAL STE 104611
CARLSBAD CA
92009-7932
US

IV. Provider business mailing address

7668 EL CAMINO REAL STE 104611
CARLSBAD CA
92009-7932
US

V. Phone/Fax

Practice location:
  • Phone: 760-750-2796
  • Fax:
Mailing address:
  • Phone: 760-750-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: