Healthcare Provider Details

I. General information

NPI: 1255970836
Provider Name (Legal Business Name): CAMILLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SUTTON WAY
GRASS VALLEY CA
95945-4102
US

IV. Provider business mailing address

457 SUTTON WAY
GRASS VALLEY CA
95945-4102
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-8114
  • Fax: 530-477-1513
Mailing address:
  • Phone: 530-477-8114
  • Fax: 530-477-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: