Healthcare Provider Details

I. General information

NPI: 1982773099
Provider Name (Legal Business Name): EVA MARIE SMITH M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT ROAD
HOOPA CA
95546
US

IV. Provider business mailing address

PO BOX 1305
HOOPA CA
95546-1305
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax: 530-625-5171
Mailing address:
  • Phone: 530-625-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberCFE42592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberCFE42592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: