Healthcare Provider Details

I. General information

NPI: 1093862781
Provider Name (Legal Business Name): ERIC V SMITH MEDICAL CASE WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-0209
  • Fax: 562-924-5706
Mailing address:
  • Phone: 562-467-0209
  • Fax: 562-924-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: