Healthcare Provider Details

I. General information

NPI: 1376397190
Provider Name (Legal Business Name): MABEL SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39233 LIBERTY ST
FREMONT CA
94538-1501
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 510-795-8186
  • Fax:
Mailing address:
  • Phone: 510-795-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95029803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: