Healthcare Provider Details

I. General information

NPI: 1124970165
Provider Name (Legal Business Name): TARA COLLEEN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5062 ALVARADO RD UNIT B
CARPINTERIA CA
93013-1488
US

IV. Provider business mailing address

5062 ALVARADO RD UNIT B
CARPINTERIA CA
93013-1488
US

V. Phone/Fax

Practice location:
  • Phone: 808-268-1057
  • Fax:
Mailing address:
  • Phone: 808-268-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: