Healthcare Provider Details

I. General information

NPI: 1851507610
Provider Name (Legal Business Name): DENISE NICOLE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH STREET SUITE 200
HAWTHORNE CA
90250-2241
US

IV. Provider business mailing address

4161 REDONDO BEACH BLVD SUITE 201
LAWNDALE CA
90260-3306
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-9010
  • Fax: 310-973-2445
Mailing address:
  • Phone: 310-214-8677
  • Fax: 310-921-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: