Healthcare Provider Details

I. General information

NPI: 1144831371
Provider Name (Legal Business Name): RAYMOND SMITH II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17117 SALDEE DR
CARSON CA
90746-1156
US

IV. Provider business mailing address

17117 SALDEE DR
CARSON CA
90746-1156
US

V. Phone/Fax

Practice location:
  • Phone: 323-373-5472
  • Fax:
Mailing address:
  • Phone: 323-373-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: