Healthcare Provider Details

I. General information

NPI: 1386853117
Provider Name (Legal Business Name): CARRON ANNE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST SUITE 101
FALLBROOK CA
92028-3081
US

IV. Provider business mailing address

27699 JEFFERSON AVE SUITE 300
TEMECULA CA
92590-2661
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-6501
  • Fax: 760-723-6521
Mailing address:
  • Phone: 951-252-8588
  • Fax: 951-252-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: