Healthcare Provider Details

I. General information

NPI: 1528683604
Provider Name (Legal Business Name): HEALTHSMITH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD PH
CULVER CITY CA
90232-2732
US

IV. Provider business mailing address

9808 VENICE BLVD PH
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 604-803-8513
  • Fax: 778-945-2778
Mailing address:
  • Phone: 604-803-8513
  • Fax: 778-945-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONIO MARTN OCANA
Title or Position: CEO
Credential: MD
Phone: 604-803-8513