Healthcare Provider Details

I. General information

NPI: 1972421386
Provider Name (Legal Business Name): KAYLA SMIETANKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24331 EL TORO RD STE 330
LAGUNA WOODS CA
92637-2754
US

IV. Provider business mailing address

14431 VENTURA BLVD # 623
SHERMAN OAKS CA
91423-2606
US

V. Phone/Fax

Practice location:
  • Phone: 949-716-0833
  • Fax: 949-716-0835
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: