Healthcare Provider Details

I. General information

NPI: 1588461966
Provider Name (Legal Business Name): BABY'S FIRST PIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W CARRIAGEDALE DR
CARSON CA
90745-5715
US

IV. Provider business mailing address

217 W CARRIAGEDALE DR
CARSON CA
90745-5715
US

V. Phone/Fax

Practice location:
  • Phone: 424-337-3516
  • Fax:
Mailing address:
  • Phone: 424-337-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEANDRE ANTHONY SMITH SR.
Title or Position: CEO
Credential:
Phone: 424-337-3516